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 Registration Form

Informed Consent

Privacy Policies

Intake form

Appointment Reminders Form

Credit Card Authorization

Technology Assisted Counseling Consent

If you are being treated or have recently been treated by another mental health or medical professional and want me to coordinate care with this provider, please fill out the Release of Information Form below.

Release of information

If you will be paying out of pocket for services, please fill out this Private Pay Agreement Form.

Private Pay Agreement

Contact Today

17806 IH 10, Suite 300
San Antonio, TX 78257
(210) 693-7131

Got Questions?
Send a Message!

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.