Make an Appointment: 914-835-3910 | drepodolak@gmail.com

drepodolak@gmail.com | 914-835-3910
Contact Now Schedule an Appointment

1600 Harrison Avenue, Suite G105A, Mamaroneck, NY 10543
drepodolak@gmail.com | 914-835-3910

banner image

Client Forms

Before your first appointment please sign the consent and privacy notice and complete the brief intake form:

If you feel that you would like to collaborate your session with another provider, simply fill out the following form.

Contact

logo

914-835-3910
drepodolak@gmail.com

1600 Harrison Avenue, Suite G105A Mamaroneck, NY 10543

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.