Client Forms

Client Forms

If you are new, please feel free to fill out these intake forms before our first session. These forms can also be filled out during the first session.

Client Intake Form

Information Sheet

Limits of Confidentiality

Informed Consent

Informed Consent for Telemental health Counseling

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

Authorization to Disclose Information

 

Contact Today



422 Coventry Dr. Suite D
Phillipsburg, NJ 08865

yomucounselingarts@gmail.com
(908) 290-8692

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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.