Client Forms

If you are new, please feel free to fill out these intake forms before our first session. These forms can also be filled out during the first session.

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

Contact

4601 Troy Hwy
Montgomery, AL 36116

(334) 467-4992
ICS.Empowers@gmail.com

Terms of Use *

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.