Help us match you to the right therapist

It's important to have a therapist who you can establish a personal connection with. The following questions are designed to match you to a licensed therapist based on your therapy needs and personal preferences.

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" Gender plays an important role in shaping personal identity and experiences. This information will help your therapist create a more personalized approach. "

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Did you know?
Almost a fifth of older adults in the United States have experienced depression. (Geriatric Mental Health Foundation, 2008)

What are the issues that you are facing?

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I prefer a therapist with experience in...

Answering this question will help your therapist know where to begin.

First Name

Last Name

Email

Phone number

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.

You've completed the questionnaire!

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