(310) 340-6597

erin@esrtherapy.com

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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.



erin@esrtherapy.com
(310) 340-6597

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Send a Message!

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