Client Forms

These forms need to be completed before your first session. Please feel free to click on the links below, print the forms, and fill them out. Don’t forget to bring them with you to our first session together. Or if you prefer, you can arrive 30 minutes prior to your first appointment to complete the forms. In this case, please let me know so I can arrange to leave the paperwork for you. Feel free to contact me if you have any questions about the forms.

Informed Consent

Telemental Health Informed Consent

HIPAA Notice of Privacy Practices

Client Information Form

Payment Form

Release of Information



drannemariejeffries@gmail.com
404-620-3149

Send 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.