(440) 836-3195 | kate@kb.hush.com

Kate Bergman LISW

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Appointment Request

Please feel free to complete the form below to request an appointment. You may also call me, or email anytime. I look forward to meeting you!

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.
Kate Bergman, LISW


(440) 836-3195
ktbergman@sbcglobal.net

24100 Chagrin Blvd Suite 370
Beachwood, OH 44122

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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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24100 Chagrin Blvd Suite 370
Beachwood, OH 44122

(440) 836-3195
kate@kb.hush.com

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