Essential components of these appointments include an ongoing professional relationship with an actively licensed medical professional with whom you currently have a professional relationship. These release/s of related information are required before other service-relevant forms will be made available.

In response to further inquiries, Tammy will respond to your request and contact you as soon as possible.

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.