Make an Appointment: | (713) 893-0506 | (713) 357-2922

Client Forms

If you are new, please feel free to fill out these intake forms before our first session. To maximize your time during the first session, please complete the forms ahead, and bring the completed forms with you to the first session.

Client Intake Form

Information Sheet

Limits of Confidentiality

If you feel that you would like me to collaborate your session with another provider, simply fill out the following form.

Authorization for Release of Information



3050 Post Oak Blvd, Suite 510
Houston, TX 77056


(713) 893-0506

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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.