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Schedule An Appointment

Please complete the form below to inquire regarding an appointment.  In the comments box please note:

 • Your insurance carrier (if applicable)

 • The issue you are wanting support with

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.