Contact

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. By providing a telephone number and submitting this form, you consent to be contacted by SMS text message. Message & data rates may apply. You can reply STOP to opt-out of further messaging