Appointment Request

Appointment Request


If you’re interested in making an appointment, please fill out the form below. I will be in touch ASAP to talk about scheduling and to answer any questions you have.

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.