Client Forms

If you are a new client, please review the following forms. If we set up an intake appointment you will be asked to fill them out online through your secure client portal.

HIPAA

Technology-Assisted Counseling Consent

Consent Policies and Agreement

Release of Information Form



904-878-3552
stellab@therapybystella.com



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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.