banner image

Schedule An Appointment

Please use the form on this page to send a message.
You may also email using the information below.

Please provide some information about yourself (e.g. date of birth) and information regarding what you would like to receive help for (e.g. anxiety, trauma, relationship issues).  I also need to verify I accept your insurance so please provide that information as well.  

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.