Appointment Request

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Giving you personal attention is my priority.

Please complete this form to contact me for scheduling. I answer all inquiries on the day they are sent.

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.