Appointment Request | Carmen Schmidt Benedetti

Please complete the form below to request a 20 minute phone consultation appointment.

I will try my best to accommodate your request and will be in touch as soon as possible, which will typically be within 1 business day. As you are waiting for a response from me, please check your spam/junk folder in case the reply gets sent there.

I am seeing clients through online appointments; however, I am only licensed to see clients located in California.

“Your vision will become clear only when you can look into your own heart. Who looks outside, dreams; who looks inside, awakes.“

NOTICE: I will be out of the office until Tuesday, May 24th, 2022. I will not be able to respond to your message until my return. Thank you.

Name *

Email *

Phone *

How did you find me *

Preferred Date and Time

Reasons for contacting *

Are you hoping to use insurance to cover services?

If you are potential new client, are you located in California?

Your Message

Yes, I want to submit this form

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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