GET IN TOUCH CONTACT

Client Registration and Forms

Please click the link below for client registration and forms.

Your Name*
Email*
Phone*
Your Message
*Only use this contact form to schedule a consultation or request a phone call to talk- no private information should be shared in this email as it is not encrypted and will not be protected.
Terms of Use*
- Yes, I want to submit this form
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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