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  • Appointment Request

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    “Someday is not a day in the week.”
    ~Sam Horn

    Let's talk.

    Notice: This form and other contact forms on this website are not intended for emergencies. If you are experiencing a psychiatric emergency; dial 911 immediately or go to your nearest emergency room. National Suicide Prevention Lifeline @ 988 or 800-273-8255 24 hours a day. 

    Please use the form below to request an appointment. Please do not email protected health information, PHI. I will be in touch within 3 business days for all appointment requests. 

    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.