Appointment Request

Please complete the form below to schedule an appointment.
I will try my best to accommodate your request and will be in touch ASAP.

("Premium appointment scheduling" option available for those who need to schedule an appointment within a short period of time & receive a comprehensive written report with diagnosis & treatment plan shortly thereafter.)

"You are one step closer to getting your questions answered so you can enjoy life again!"

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.