Make an Appointment: rafael@pacificwellnessonlinetherapy.com | (760) 693-9675
Contact
rafael@pacificwellnessonlinetherapy.com | (760) 693-9675

Appointment Request

Please complete the form below to schedule your FREE 15 minute consultation.
I will try my best to accommodate your request and will be in touch soon.

Everything you've ever wanted is on the other side of fear.
-George Addair
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.

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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.

  • Have some questions first? You can always reach out here, or email me directly at rafael@pacificwellnessonlinetherapy.com