Make an Appointment:
[email protected]
|
(727) 998-1807
[email protected]
|
(727) 998-1807
Home
About
Services
Clients
Resources
Frequently Asked Questions
Rates & Insurance
Crisis Resources
Client Portal
Contact
Close menu
Home
About
Services
Clients
Resources
Frequently Asked Questions
Rates & Insurance
Crisis Resources
Client Portal
Contact
Client Forms
In English
In Spanish
Client Forms
If you are a new client, please fill out these forms before our first session. If you opted in, you can receive them by email.
Client Intake Form
Information Sheet
Limits of Confidentiality
To authorize Into Focus Psychotherapy and its providers to communicate with another health provider or another person, please also fill out the following form.
Authorization for Release of Information
FL
(727) 998-1807
[email protected]
Please enable JavaScript in your browser to complete this form.
Name
*
Email
*
Phone
Comment or Message
*
Terms of Use
*
Yes, I want to submit this form
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.
Email
Submit
