Appointment Request Please complete the form below to schedule an appointment and Eli will contact you within 24 hours to arrange a free phone consultation! Eli can also be reached at (814)-461-6788 or via email at elirosenblatt@yahoo.com. Please enable JavaScript in your browser to complete this form.Name *E-mail *PhoneWill you be using insurance? *If so, from which company?What would you like to work on in therapy?Terms of Use *Yes, I want to submit this formBy 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.NameSubmit
