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By providing your mobile phone number, on the form below, you are agreeing to receive SMS messages from Achieving Changes Counseling Services, PLLC. This includes SMS messages for customer care. Message frequency varies. Message and data rates may apply. See privacy policy for more inforamtion . Message HELP for help. Reply STOP to any message to opt out.

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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.