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    New Patient Registration Form

    Please fill out the below form to receive access to our encrypted intake forms.

    List of our services:


    ClubMed         VetMed         OccMed

    Please include which service/s you are interested in when you fill out the form

    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.