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3000 El Camino Real, Building 4, Suite 200, Palo Alto, CA 94306

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"Let go of the battle. Breathe quietly and let it be. Let your body relax and your heart soften. Open to whatever you experience without fighting."

-Jack Kornfield

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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.

3000 El Camino Real, Building 4, Suite 200, Palo Alto, CA 94306
terri@terriolivatherapy.com
(650) 691-5653

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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.

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