Appointment Request

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.

*We are considered Out of Network and we do not accept insurance. We are happy to provide the forms necessary for you to receive possible reimbursement from your insurance. We also do not accept Medicaid clients at this time.

**Responses to inquiries often go to spam. Please check spam/ junk folder if.