Request Appointment To request an appointment with Debbie Cohen, MA please fill out the form below. Your Name* Email* Phone*Preferred Date MM slash DD slash YYYY Preferred Counselor Additional CommentsTerms 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. Δ
