Appointment Request

Use this form to send a request to Healing Hearts Counseling for an adolescent, family or individual counseling appointment. Someone will respond to you shortly to finalize your session date and time.

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.