Gestalt

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Contact Our Team

Saw someone on our team that you think would be a good fit for you? Use the form here to send them your questions!

Who Would You Like to Contact? *

Use this dropdown to select the counselor or therapist that you wish to send a message to using this form.

Your Name *

Email *

Phone Number

Please provide a few good times to reach you by phone:

Your Message

By submitting this form via this web portal, you acknowledge and accept that 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. *

Yes, I want to submit this form

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