Client Forms

If you are new to the working with me, please be sure to fill out the following forms, and bring them to your first session. This will help ease you in and allow as much time as possible to focus on you. If you will be doing telehealth you can email the forms to me. If you have questions please call or text 970-286-0054.

Name *

Email *

Phone

By entering your phone number and checking this box, you agree to receive informational SMS messages (appointment reminders, account notifications, etc.) from us. Message frequency varies. Message and data rates may apply. For help, reply HELP or email us at sally@connecttherapiesllc.com. You may opt out at any time by replying STOP. Click here for Terms & Conditions / SMS Privacy Policy.

Preferred Time and Date

Comment or Message

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. *

Yes, I want to submit this form & agree to the terms of use.

Name