National Suicide Prevention Lifeline
1-800-273-8255

info@innerpeacebh.net

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.

HIPAA Form

Limits of Confidentiality

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

Client Release of Information Form

Contact Today



100 Maple Street, Suite 208,
Wyandotte, MI 48192

info@innerpeacebh.net
(734) 407-8913
Fax: (734) 258-8229

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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.