Appointment Request

Appointment Request

Please complete the form below to schedule an appointment.
I will try my best to accommodate your request and will be in touch ASAP.


"Paths are paths - they make it easier to follow the same route again. They also discourage finding other routes, so pick with care, and try new ones whenever you can." - Unknown

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.