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

Client Information Sheet

Limits of Confidentiality/Therapy Cancellation Policy

Authorization for Use or Disclosure of Protected Health Information



(978) 407-3291

(813) 281-8955

(813) 281-2474

1211 N. Westshore Blvd. Suite 411
Tampa, FL 33607
Virtual appointments on all other days,
except Sundays, are also available.

davelapens@aol.com

Have Questions?
Send me a Message!

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.