In Person Office Visit Consent Form

Please email completed and signed forms to:

Discovery Psychotherapy Center: info@discoverypsychcenter.com

Discovery Wellness Center: info@discoverywellnesscenternj.com

IN-PERSON SERVICES CONSENT FORM

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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