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541-399-5774 | jsvincenzo@gmail.com

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Jessica Vincenzo

Start Here

Client Forms

If you are new, please be sure to fill out the following forms, and bring them to your first session. This will help ease you in and allow as much time as possible to focus on you.

Outpatient Services Contract

HIPAA Notice Form

Cancellation Policy

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

Mutual Authorization Form

Web Portal for Current Clients

706 Columbia Street
Hood River, OR 97031

541-399-5774
jsvincenzo@gmail.com

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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.
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