(714) 291-0793

DrCherylDale@gmail.com

Client Forms

If you are new, please feel free to fill out these intake forms before our first session. These forms can also be filled out during the first session.

Client Intake Form

Information Sheet

Limits of Confidentiality



1151 Dove Street Suite 220
Newport Beach, CA 92660

DrCherylDale@gmail.com
(714) 291-0793
*For text messages, please contact 949-315-1712*

Got Questions?
Send a Message!

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.