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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.

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(267) 282-1175

sdavis@drshadanadavis.com

11 W. Highland Ave Pennsylvania, PA 19118



11 W. Highland Ave
Pennsylvania, PA 19118

sdavis@drshadanadavis.com
(267) 282-1175

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DISCLAIMER: This form is not HIPAA Compliant. Do not send any protected health information via this contact 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.