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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 @800-273-8255.

    Please use the form below to request an appointment. Please do not email protected health information, PHI. I will be in touch within 24 hours for all appointment requests M-F. I will return any weekend appointment requests on the next business day.

    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.