School Authorization Form Request

You can request a 'School Authorization Form' through our confidential, secure, HIPPA compliant portal. Simply, complete the information below. Please Type  *Requesting School Authorization Form' in the 'Message Section'. Once we receive your request, we will email your document to the Email Address you provide.

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.