Appointment Request

Appointment Request

At Northwest Couple and Family Therapy, we recognize that it takes courage to reach out. We appreciate you choosing to work with us and will be in contact with you soon.

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.