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.

Social Media Policy

Office Policies

North Carolina Notice of Privacy Practices

Intake Form

Administrative Policy

FL Notice of Privacy Practices

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

Authorization for Release of Information

 

Contact Today



11010 Lake Grove Blvd, Ste 100-124
Morrisville, NC 27560

hawanya@movetowardchange.com
(919) 589-5393

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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.