Counseling Appointment Request

Please complete the form below to request an appointment with one of our counselors.

717-602-5560

info@parentfamilysolutions.com

Teletherapy Office: HIPAA-Secure Online Counseling

Harrisburg Office: 160 S. Progress Ave., Ste 3A, Harrisburg, PA 17109-0000

Lancaster Office: 1681 Crown Ave, Ste 101, Lancaster, PA 17601

Name *

Email *

Phone

If you are requesting an appointment with a specific counselor, please list their name:

Comment or 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.

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