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.

Client Intake Form

Authorizations

Client Consent

Information Sheet

Hypnotherapy Disclosure Form

Limits of Confidentiality

Notice of Privacy Practices

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

Authorization for Release of Information



6000 A Sawgrass Village Circle, Suite 7
Ponte Vedra Beach, FL 32082

lewisjmoskowitz@outlook.com
(904) 770-9717

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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.