Appointment Request

To set up a free 30 minute No-Obligation Consultation/Visit/Phone call or schedule an appointment call Stacy at 952-215-5208 fill out the e-mail form below. If you are e-mailing below, please state that you would like a consultation/visit.

I am committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website. This form is for general questions or messages to the practitioner.

* Please note that if you schedule a free 30 minute consultation/visit and do not make the appointment, the next step, if you should continue with me, would be to schedule a paid 60 minute session.  There is one opportunity for a free consultation/visit.

  • Date Format: MM slash DD slash YYYY
    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.
  • This field is for validation purposes and should be left unchanged.