Get in Touch

Please complete the form below to schedule an appointment. Our typical response time is 24-48 hours. Completing the appointment request form has the quickest response time.

Name

First Name

Last Name

Phone

(###)

###

####

Preferred Date & Time

Type of Service Preferred

Virtual Sessions Only

In Person (In Barrington)

No Preference and/or Both

How Did You Hear About Us?

What type of insurance do you have?

Message

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.

Yes, I want to submit this form & agree to the terms of use. *