Appointment Request

Please complete the form below to schedule your first appointment or free 15 minute phone consultation. I will get back to you as soon as possible and within one business day. I look forward to hearing from you!

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.