• Appointment Request

    Appointment Request

    You can complete the form below to request an appointment or just call or email me.

    Which ever method, you choose to request and appointment, please remember not to provide too much personal information or detail, especially on this form.   We can talk about what I can help you with, when I reach back out to you.  I respect your privacy and want to protect your personal information.  Submitting this form online may involve a certain level of risk.

    My email and and phone number are HIPAA compliant.  They are encrypted to protect your personal health information.

    The systems you regularly use may not be.

    If you just leave me your first name and contact information, I promise to call you back or I will use an encrypted email portal you can log into for us to communicate. I will get back to you as soon as possible.

    If you’d like to leave the best days and times to contact you, I will try my best to accommodate your request within my schedule.

    You Simply Can’t Go Wrong When You Make Yourself A Priority

    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.

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