Appointment Request

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


"As you start to walk on the way, the way appears." - Rumi

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.


636 Church Street, STE # 510
Evanston, IL 60201

info@andcounseling.com
847-868-2132

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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.

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