Appointment Request

Please complete the form below to schedule an appointment.
I will try my best to accommodate your request and will be in touch ASAP.


"Only when we are brave enough to explore the darkness will we discover the infinite power of our light."
~ Brené Brown ~

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.


info@westlakevillage-therapist.com
(805) 849-7828

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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.

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