mshassllc@gmail.com
417-256-5669

HASS, LLC

  • Home
  • About HASS, LLC
  • HASS Team
  • Contact

Client Forms

If you are new, please be sure to fill out the following forms, and bring them to your first session. This will help ease you in and allow as much time as possible to focus on you.

Client Intake Form

Information Sheet

Limits of Confidentiality

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

Authorization for Release of Information

Contact Today

417-256-5669
mshassllc@gmail.com

1480 W 8th Street
West Plains, MO 65775

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.

Contact Us

1480 W 8th Street
West Plains, Missouri 65775
 
417-256-5669

mshassllc@gmail.com

Clinic Location



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.

Privacy Policy

A bright site by Brighter Vision  
© 2019 HASS, LLC. All rights reserved.

Copyright © 2023 · Bookshelf on Genesis Framework · WordPress · Log in