Client Forms

If you’re a new client, please complete the following forms and bring them to your first therapy session.

Client Psychotherapy Intake Form
Limits of Confidentiality/Therapy Cancellation Policy

Limits of Confidentiality

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



539 Rock Spring Road
Bel Air, MD 21014

cultureofsuccess@gmail.com
(310) 377-1610

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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.