Contact

Our availability for new clients varies. When our therapists are not currently taking new clients, we keep a small wait list when client and therapist strongly believe we are a good fit to work together. Information below is for when your preferred therapist has an open wait list. Feel free to contact us...

If you are not needing an intake immediately (could wait 2+ months for the right therapist)
If you will have daytime availability for appointments
If you are looking for therapy within one of our specialties (i.e. EMDR, IFS-Informed EMDR, Therapy for Mental Health Professionals)
If you have a specific referral from another professional (please include their name on the contact form)
If you'd like to receive or share other information

Contact Us Today!

Name *

Email *

Phone *

DOB *

City & State where you live *

What type of service are you looking for?

If you have specific scheduling needs, please share them here so we can assess whether we can accommodate. (You can also indicate: Flexible) *

How do you intend to pay for services?

How did you find us?

Name of referring person (when applicable)

Other Comments

All our therapists work only with clients residing in Pennsylvania at this time (due to licensing laws) and some of our therapists only see adults. Clients accepted for therapy will need to give Date of Birth and the City & State where you will be when you receive services. Feel free to include these in the message portion of this form. Or you can provide them when our Administrative & Billing Specialist contacts you.

Yes, I want to submit this form

By submitting this form via this web portal, you acknowledge and accept that 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.

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