Appointment Request Please complete the form below to request an appointment. Please be cautious with the information you provide – the form is not encrypted. We look forward to meeting you! A place where you can be you. Please enable JavaScript in your browser to complete this form.Name *Email *PhonePreferred Date & TimeComment or MessageTerms of Use *Yes, I want to submit this formBy submitting this form via this web portal, you acknowledge and accept that 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.CommentSubmit