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.

MCA Social Media Policy

Informed Consent Testing

MCA Demographic

Notice of Privacy Practices


info@midwestca.com
Phone: 417-255-8790
Fax: 417-222-6991

412 Washington Ave
West Plains, MO 65775

Online Counseling

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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.