Appointment Request Please fill out your name to contact me. Once you fill this out, you’ll be taken to a secure contact form where you can contact me through an encrypted form for maximum security. Please enable JavaScript in your browser to complete this form.Name *Terms of Use *Yes, I want to submit this formBy 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.MessageSubmit
