Schedule An Appointment

Please complete the form below to request an appointment. In the comment section, please indicate the best way to reach you (email, phone, or text), and provide a brief explanation of the services you are interested in.

717-742-0633

rmyerslpc@gmail.com

347 South Market St, Elizabethtown, PA 17022

Name *

Email *

Phone

Preferred Date & Time

What Kind of Session are You Looking For? *

1) 90-minute appointment
2) Mini-intensive (3–4-hour appointments)
3) One-day or Two-day Intensive

Comment or 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.

Yes, I want to submit this form & agree to the terms of use. *