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2630 W. Fletcher Ste 11 Chicago, IL 60618

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2630 W. Fletcher Ste 11
Chicago, IL 60618

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(773) 524-2685

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By submitting this form via this web portal, you acknowledge and accept that 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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