Integrative Wellness Counseling, LLC

Appointment Request

Please complete the form below to request an appointment with Integrative Wellness Counseling LLC. I will be in touch with you within 48 hours.

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.

*While Gmail Mail employs SSL encryption to secure e-mail exchanges, e-mail is inherently insecure. For this reason, you may not want to discuss sensitive matters through e-mail. My office is concerned about the privacy of your medical information and e-mail exchanges may be read by others. I strongly recommend that we use face-to-face or telephone communication to discuss any matters related to your health and welfare. I will reply briefly to your e-mails unless you specifically ask me not to do so and will call you to schedule an appointment or answer any questions.