Client Forms

Client Forms

If you’re a first-time client, please review and complete the following forms and bring them to your first session.  The first three forms must be filled out and brought to the first appointment.  The Notice of Privacy Practices is at the top of this page.  Please read it to be informed about HIPAA.

Please fill out this form if you are coming in for couple of family counseling.

If you would like me to coordinate care with another provider (for example, your psychiatrist, endocrinologist, etc.), complete these forms:

If you would like to pay by credit card, please fill out this form:

Please fill out this form if you are participating in telehealth.

Contact Today

5535 Balboa Blvd. suite 206
Encino, CA 91316
(818) 783-4032

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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.