Client Forms

Intake Paperwork

Anxiety Screening

Substance Abuse Assessment

Depression Screening

Credit Card Authorization Form

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

Authorization to Disclose Information Form

Note: To download Adobe Acrobat Reader for free, click here.

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Concord on the Creek
6750 Hillcrest Plaza Dr.
Suite 304
Dallas TX 75230

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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.

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