Appointment Request

Appointment Request

Please complete the form below to schedule an appointment. I will call you back either on Monday evening between 6pm-7pm or Thursday afternoon between 12pm-2pm to discuss potentially scheduling an initial appointment. I look forward to connecting with you!


Difficult Roads Often Lead to Beautiful Destinations

By submitting this form via this web portal, you acknowledge and accept that 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.