Schedule An Appointment

Please complete the form below to schedule an appointment.
I will try my best to accommodate your request and will be in touch ASAP.

[email protected]

(201) 906-5726

1605 John Street, Suite 314, Fort Lee, NJ 07024

Name *

Email *

Phone

Preferred Date & Time

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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.

Counseling Services Inc is not held liable for any unencrypted information or communications transmitted via this website. 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.

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