New Paradigms Therapy Group Registration Form Please enable JavaScript in your browser to complete this form.I am signing up for:Therapy Group starting: November 7th, 2020 to February 13th, 2021Select a Payment Option *$240 first out of two payments$450 for the 8 session groupI understand that this is a non-refundable fee that is required regardless of attendance.By submitting this form via this web portal, you acknowledge and accept that 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 formNameSubmit
