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Consultation Request

Please complete the form below to schedule an appointment.

Please fill out the form below, and I will reach out to you to set up a free initial consultation call to answer questions about my services and discuss your goals and vision.

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.