Appointment Request Are you ready to Set and Appointment? You can request an initial appointment/consultation by filling out the contact form below. Your Name* Email* Phone*Preferred Date MM slash DD slash YYYY Additonal CommentsTerms 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.CAPTCHA