Client Forms

You will receive all of these consents electronically through our electronic health records, however, here are copies of all our forms for your review.

Contact Today

Name *

Email *

Phone

Comment or Message

I agree to receive text messages from Nourish The Heart Counseling. I understand that message frequency varies and data rates may apply. I understand that I may opt-out by replying "STOP" at any time. I understand that I may reply "HELP" for assistance. I understand consent is not required to purchase goods or services.

Yes, I want to submit this form

I agree with the Privacy Policy and Terms and Conditions. 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.

Name

Client Forms

Office Hours

Emergency Information

Contact Information