Client Forms

If you’re a first-time client, please review and complete the following forms, bring them to your first session.

Participant Intake Form

Pacific Assistance Group North Clients can access these helpful forms:

Contact Today

Name *

Email *

Which location are you trying to reach?

Northern Location
Southern Location

Phone

Comment or Message *

We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website.This form is for general questions or messages to the practitioner.

Yes, I want to submit this form

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.

Comment