Client Forms

If you are new, please feel free to fill out these intake forms before our first session. These forms can also be filled out during the first session.

Experience Survey

Client Information

Questionnaire

Client Information #2

 

Contact Today



7451 Switzer Road Suite 120
Shawnee, KS 66203

115 S Sycamore Street
Gardner, KS 66030

contact@pureperfectfaith.com
(913) 787-5444

Got Questions?
Send a 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.