Appointment Request

408-430-3312 mike@gilroycounseling.com

Please complete the form below to schedule an appointment. I will try my best to accommodate your request and will be in touch ASAP. Please be aware that we do not accept insurance as payment and current only have morning and early afternoon weekday availability.

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.

Find My Office

8371 Church Street Gilroy, CA 95020
408-430-3312
mike@gilroycounseling.com