Empowering people to live bravely and authentically

Client Forms

Client Forms

If you are new, please feel fill out these intake forms and bring them to our first session.

Registration Form

Privacy Policy

Privacy Policy Acknowledgement Form.

Your privacy is important to me, and so is your continuity of care.  If you feel that you would like me to collaborate with another provider, please fill out the following form.  We will discuss in session what you would like me to share or not share and what I think might be clinically important to share before I speak with another provider.

Authorization for Release of Information


Contact Today

4809 St. Elmo Ave.
Bethesda, MD 20814

(240) 205-4677

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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.