Appointment Request If you would like to schedule a therapy session with Fort Lauderdale Therapy Center, use the form below to send your details. Someone will respond shortly to finalize your session date and time. Please enable JavaScript in your browser to complete this form.Name *E-mail *PhonePreferred DateComment or Message *Terms of Use *Yes, I want to submit this formBy 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.NameSubmit
