Refer A Friend or Family Member

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Today marks the day you made a decision to help a friend or family member get the help they need. We understand the difficulties in seeking help for some individuals, but it’s important to realize that you can make a big difference for them. 

We made the referral process simple and confidential. After you complete and submit the referral information below, a Clinical Intake Coordinator will contact the referral and inquire about their interest in services. 

Rates and Insurance

Refer a Friend or Family Member

Complete the information below and we will reach out to you or the person you are referring. We normally respond to new  referrals within 24 hours. 

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.