• Appointment Request

    Appointment Request

    Please complete the form below to schedule an appointment. I’ll be in touch as soon as possible.

    “If you get up one more time than you fall, you will make it through.”

    Chinese Proverb

    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.