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Appointment Request

Complete the form below to schedule a session.  Please provide all the days and times you are generally available to meet.  I will try my best to accommodate your requested times and will be in touch as soon as possible.  I look forward to talking with you!

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.