Request Services For Myself

banner image

You are not alone! We are here to help and we've made it really simple for you to get the help you need. 

We made the referral process simple and confidential. After you complete and submit the referral information below, a Clinical Intake Coordinator will contact you to get you started.

 Rates and Insurance

We've Made It Easy To Start Services

Simply complete and submit the information below and someone will reach out to you to schedule your first appointment with Adaptive Behavioral Health. 

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.