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45445 Portola Avenue, Suite 1 & 4 Palm Desert, CA 92260

Phone: (760) 385-3959

Fax: (760)406-5621

info@therefinerywellness.com



45445 Portola Avenue, Suite 1 & 4
Palm Desert, CA 92260

info@therefinerywellness.com
Phone:(760) 385-3959
Fax: (760)406-5621

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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.