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1623 Third Avenue Suite 201 New York, NY 10128

(917) 922-0156

emammone1@aol.com



1623 Third Avenue Suite 201
New York, NY 10128

emammone1@aol.com
(917) 922-0156

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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.