Appointment Request

Appointment Request

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


"You don't have to get stuck in a negative experience. You don't have to be a victim to external events, or internal emotions. You can use your mind to take charge of how you feel, and how you act."

-Dan Siegel

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.