Eric Hamrick | Life Connect Counseling

Appointment Request

Please complete the form below to schedule an appointment.  We start all new clients off with a FREE 20 minute phone consultation.  During that time we answer and questions you may have about counseling, our practice and procedures.  It is a time for us to get to know one another and determine if this is a good fit.  We then move to set up an initial assessment to determine your needs.

Please list times in the form when you can complete a 20 minute phone consultation.  We will try my best to accommodate your request and will be in touch ASAP.

We are here for you.
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.