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  • Refer a Client or Patient

    Please use the box below to put patient/client information and I will reach out to them directly. 

    Also, leave your contact information in the message box so I know who is referring & your contact information. 

    Thank you & look forward to working with you.

    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.