Appointment Request

Please complete the form below to schedule an appointment.

Please note: We understand that technology has its glitches at times. We strive to respond to your inquiry within 24 hours. However, if you do not hear back via phone or email within one business day, please contact us at and we will address the situation as soon as possible.

"The future depends on what you do today."
- Mahatma Ghandi

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.