(562) 353-5335

therapy@coupleshealingcenter.com

Client Forms

Once you book an appointment with me and complete the payment you will receive the intake forms via email. You can download these fillable forms and upload it in the portal when completed.

You may also fill out these interactive forms below:



444 Larchmont Blvd. Los Angeles, CA 90004
3711 Long Beach Boulevard #500 Long Beach, CA 90807


therapy@coupleshealingcenter.com
(562) 353-5335

Get Help Today!

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.