Client Forms

Client Forms

If you are new please fill out these forms on my Client Portal prior to our first session.

If you feel that you would like to collaborate your session with another provider, simply fill out the following form.

Authorization for Release of Information

 

Contact Today



7475 W 5th Ave Ste. #210
Lakewood, CO 80226

mark@marklafleur.com
(303) 475-4603

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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.