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Appointment Request

Appointment Request

Did you want a FREE 15-minute consultation?

Please complete the form below to schedule your appointment.
I will try my best to accommodate your request and will be in touch ASAP.

"If you change the way you look at things, the things you look at change"
– Wayne Dyer

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.

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