• Appointment Request

    Appointment Request

    Please complete the form below to request an appointment.
    I will be in touch ASAP.

    “Courage starts with showing up and letting ourselves be seen.”
    – Brene Brown

    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 Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.