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    1101 Scott Avenue Suite 28 | Wichita Falls, TX 76301
    info@holistic-balancepllc.com | (940) 277-2400

  • Lavon Williams

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    Client Forms

    If you are new to the working with me, 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

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    1101 Scott Avenue Suite 28 Wichita Falls, TX 76301

    (940) 277-2400 contact@holistic-balancepllc.com

    Contact Today

    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.

    Holistic Balance, PLLC
    contact@holistic-balancepllc.com | (940) 277-2400

    Holistic Balance, PLLC

    A Website by Brighter Vision | Privacy Policy

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