Appointment Request

Appointment Request

If you would like schedule an appointment with Susan M. Keefer for an individual, couples or family therapy session, fill out the form below. Paul will get back to you as soon as possible to finalize your session time and date.

    Your Name (required)

    Your Email (required)

    Phone

    Preferred Date(required)

    Your Message

    Terms of Use*

    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.