Counseling Appointment Request | Marriage & Family Counseling | Natick, MA

Please complete the form below to request an individual, couples, adolescents or family counseling appointment with Daniel I. Schacht, LICSW. I will try my best to accommodate your request.

Your Name*
Email*
Phone*
Preferred Date
MM slash DD slash YYYY
Additonal Comments
Untitled*
- 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.