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1221 Kapiolani Blvd., Suite 248 Honolulu, HI 96814

1-314-451-1588

dalekomoda@icloud.com



1221 Kapiolani Blvd., Suite 248
Honolulu, HI 96814

dalekomoda@icloud.com
1-314-451-1588

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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.