Make an Appointment: kimberly@releasereviverestore.com | (562) 353-8973

kimberly@releasereviverestore.com | (562) 353-8973

Appointment Request

Please complete the form below to schedule an appointment.
I will try my best to accommodate your request and respond within 36 hours.

"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.

3711 Long Beach Blvd, Suite 5065
Long Beach, CA 90807

(562) 353-8973
kimberly@releasereviverestore.com

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.