Appointment Request Please complete the form below to schedule an appointment. Requests will be responded to within 1-2 business days. Therapy for Individuals, Couples, & Families Specializing in Neurofeedback Please enable JavaScript in your browser to complete this form.Name *Email *Phone Preferred Day and TimeComment or MessageTerms of Use *Yes, I want to submit this formBy 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.NameSubmit
