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262-221-3971
julie@juliefordmft.com
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Appointment Request

Please fill out the form below to request a counseling appointment, I will try to accommodate your request as best as possible.

  • Date Format: MM slash DD slash YYYY
    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.

Contact Info


Julie Ford, MFT
15850 W. Bluemound Road Suite 316 Brookfield, WI 53005
262-221-3971 julie@juliefordmft.com

Contact Me

    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.
  • 15850 W. Bluemound Road Suite 316 Brookfield, WI 53005
  • 262-221-3971  |  julie@juliefordmft.com
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