Contact

Reach out to us today!

If you would like to start the new patient registration process, please fill out this form completely and it will automatically go to our referral specialist ([email protected]). Please email a copy of your insurance card (front and back) to this address as well. An administrative staff member will contact you within 48 hours and provide our best estimate of your insurance benefits and the best fit clinical provider. Please also contact your insurance company directly for information regarding your benefits.

Click here to get started:  New Patient Referral Form

Please feel free to contact us with any questions you may have. Our administrative staff will respond and help provide as much information as possible. Please do not use this contact for emergencies or clinical questions. It is best to reach out to your provider with clinical questions by calling and leaving a message for them on their extension.

In an emergency, please contact 911 or Georgia Crisis and Access Line at 1-800-715-4225 or go to your local emergency room.

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.