Appointment Request

Please complete the form below to schedule an appointment for your free phone consultation. I will try my best to accommodate your request and will be in touch as soon as possible.  Please include the type of service you are interested in, your days of availability, and what if any insurance you would like to use.


Not everyday is good, but there is something good in everyday.

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.