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    Please use the button above to request an appointment or the form on this page to send a message. You may also reach us by phone or email.

    Please include the reason you are seeking counseling and your insurance provider.

    By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.