214-440-7980 | bsmith@selahdallas.com

Selah Christian Counseling

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Appointment Request

Please feel free to complete the form below to request an appointment. You may also call me, or email anytime. I look forward to meeting you!


"Your life doesn't get better by chance it gets better by change."

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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.

Bryan Smith


214-440-7980
bsmith@selahdallas.com
Fax number:972.645.5624

2414 Marsh Lane, Suite 100, Unit D
Carrollton, TX 75006

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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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Contact Information

2414 Marsh Lane, Suite 100, Unit D
Carrollton, TX 75006


214-440-7980
bsmith@selahdallas.com
Fax number:972.645.5624

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