Appointment Request

Please fill out the below form to request an appointment. Include your preferred day(s) and time(s) in the message.

First name

Last name

Your email

Email subject

Your phone

Your message

By submitting this form via this web portal, you acknowledge and accept that 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 Bridge to Restoration Therapy Services harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

Message Sent!

Your message has been sent successfully, I hope to respond within 24 hours. You can also contact us through email or phone call!

Address

2920 Fuller Ave Suite #208
Grand Rapids, MI
US

Phone

(616)551-2916

Email

[email protected]