Appointment Request

 


“Courage starts with showing up and letting ourselves be seen.” -Brene Brown


 

Please complete the form below to schedule an appointment. You can also reach me by phone call or text.
I will try my best to accommodate your request and will be in touch ASAP.

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.