Therapy with Shameela

Appointment Request

Please complete the form below to schedule an appointment. I will try my best to accommodate your request and will be in touch ASAP. If this is a mental health emergency, please visit your local hospital ER or call 911. Please, No Soliciting.

Please be aware that new couples may have to wait 2 to 4 weeks to obtain an appointment.
In addition, I am currently unable to take on new minor clients (under the age of 18).

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.