973-796-3760 |
[email protected]

862-242-3500 | [email protected]
[email protected] | (973)796-3760

  • (973)796-3760
    [email protected]
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    In Person Office Visit Consent Form

    Please email completed and signed forms to:

    Discovery Psychotherapy Center: [email protected]

    Discovery Wellness Center: [email protected]

    CONSENT FOR IN-PERSON SERVICES PUBLIC HEALTH FORM

    Contact

    (973)796-3760
    [email protected]

    7E Frederick Place, Suite 700
    Cedar Knolls, NJ 07927

    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.