Appointment Request Please use the form below to request an appointment. Please enable JavaScript in your browser to complete this form.Name *E-mail *Phone NumberPreferred Appointment Date and TimeComment or Message *Yes, please contact meBy reaching out to us through the website you agree to be contacted by one of the therapists and/or the practice manager.Terms of Use *Yes, I want to submit this formBy 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.CommentSubmit
