(281) 930-5719

admin@charmainelpc.com

Client Portal

Appointment Request

Until further notice, I am only providing telehealth appointments. Please complete the form below to schedule your free 15-minute consultation. I will try my best to accommodate your request and will be in touch ASAP.

“I look forward to embarking on this journey with you.”
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.