Request your Superbill

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We gladly provide Superbills, or statements for insurance reimbursement, by request. Please complete the form below to request your, or your child's, Superbill. We will do our best to accommodate your request in a timely manner. Thanks! 

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.