Appointment Request

Please complete the form below to schedule an appointment.
Our staff will try to accommodate your request and a staff member from EIC will be in touch ASAP.

Uncover your true potential.

By submitting this form via this web portal, you acknowledge and accept that 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.