Consultation Request

Consultation Request

Please complete the form below to schedule a complimentary 15 minute consultation.
We will try our best to accommodate your request and will be in touch ASAP.


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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.