Appointment Request

Appointment Request

Please fill out the form to schedule your free 20 minute consult! The consult is a way to ensure that we are a good match in working together. Thank you for your interest I look forward to connecting soon. I will do my best to accommodate your request and will get back to you ASAP.


"The waves of the sea help me get back to me." - Jill Davis

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.


marchickdaniella@gmail.com
(503) 683-3179

Have questions?
Send a 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.

Office is located in NE Portland or Online