Client Forms

If you are new, please feel free to fill out these intake forms before our first session. These forms can also be filled out during the first session.

Melissa Russiano, LCSW, CDWF

Jennifer Pfeffer, LCSW

Bruce Kobal, PhD

Contact Today



3939 West Ridge Rd Suite B47
Erie, Pennsylvania 16506

info@independentcounselingservices.org
(814) 923-8410
fax: (814)-315-6044

Got Questions?
Send a Message!

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.