Request to be added to Waitlist (summer 2026)


Please complete the form below .

Specify the type of service you are interested in: Consultation, Psychological Assessment, Individual, Couples or Family Therapy. 

Evening Appointments: Mon, Tues, Weds, Thurs 5:30pm or 7pm

Sundays Appointments: 10am - 4:30pm

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.