Client Forms

After we’ve agreed on your first session time, I’ll email you a login to my secure client portal – where you can provide the background needed for our first session.  If you’re unable to access the secure client portal, please complete these intake forms before our first session and bring them along with you:

Client Intake Form

Information Sheet

Limits of Confidentiality

If you would like your session summary to be shared with another provider, simply fill out the following form:

Authorization for Release of Information



30 W Main St Suite 205
Walla Walla, WA 99362

meriha@eastsidecounseling.org
T (206) 300-9436
F (509) 524-8572

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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.