New Client Packet

January 9, 2019 by MIchelle Aletkin Leave a Comment

New Client Packet

2451 McMullen Booth Road Suite 200 , Clearwater,
Florida 33759-1362

(727) 491-3999
info@bettercarecounseling.com

Send a Message

Name *

E-mail *

Phone

Comment or 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

Email

Privacy Policy

A Bright Site by Brighter Vision