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Client Forms Copy

Client Forms Copy

You will need to fill out and submit new client forms prior to our first visit. Review of your therapy goals and any past experiences allows me to be better prepared for our visit. Please submit the forms to and we will contact you to set up an appointment.


Client Intake Form

Information Sheet

Limits of Confidentiality

Clear Mind Credit Card Authorization

If you feel that you would like to collaborate your session with another provider, simply fill out the following form.

Authorization for Release of Information
(904) 733-7333

Clear Thoughts
Clear Goals
Clear Minds

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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