Appointment Request

Appointment Request

Please complete the form below to request an appointment. Please include a brief description of why you are coming in, your insurance type, scheduling needs and if you have a specific clinician you would like to work with. We are happy to answer any questions you might have.


She believed she could, so she did

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.

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