Appointment Request

To schedule an initial consultation for individual, adolescent, or couples therapy, or to obtain additional information about any of these services, please fill out the form below or give me a call.

Your Name*
Email*
Phone
Preferred Date
MM slash DD slash YYYY
Additonal Comments
Terms of Use*
- Yes, I want to submit this form
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.
Email
This field is for validation purposes and should be left unchanged.

Robert Riethmiller, Ph.D.

Psychologist and Psychoanalyst

Appointment Request