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100 Broadhollow Road, Suite 108 Farmingdale, NY 11735

(631) 769-7763

cceballos@livewellpsychotherapyli.com



100 Broadhollow Road, Suite 108
Farmingdale, NY 11735

cceballos@livewellpsychotherapyli.com
(631) 769-7763

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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.