Appointment Request

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Please complete the form below before you schedule an appointment so we may find the best time to meet your needs.
I will try my best to accommodate your request and contact you ASAP.

Book an Appointment

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.