Client Forms

Once you request an appointment you will be given a link to my secure client portal.  Through the portal you will be guided to complete basic intake information online. 

I look forward to connecting with you. 

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Navigating life’s challenges skillfully

109 Old Kingston Road, Suite 3
Ajax, Canada L1T 3A6

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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.