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The Eye Care and Surgery Center


 
 
We can help you determine if LASIK Laser Eye Surgery
is right for you. It is our pleasure to provide you with a
Free* Consultation.
Schedule your Free Consultation Today!
 

The Eye Care and Surgery Center
is dedicated to providing you with individualized and personalized LASIK education and care at every step of the process in order to make certain that you receive the best care and achieve your personal goals.

The Eye Care and Surgery Center has arranged to provide you with a
FREE Consultation Today!
 

 Please complete the following form (ALL Fields are required items*)

First Name:*

 Last Name:*

 Address:*

  City:*

 State:*

 Zip:*

Phone:*

 E-mail:*

Please Answer The Following Questions

I wear

Glasses Contact Lenses
Bi focals / Reading glasses

I wear my glasses and/or contact lenses to see
Distance Near Both Distance and Near
I am interested in having Laser Vision Correction within
the next month 6 months
3 months 12 months

Please Indicate Your Acceptance.

Please contact me to schedule a
Complimentary Consultation
A Treatment Date
Please contact me regarding
Corporate Benefit Programs
An affordable payment plan
Please include me in further informational mailings

 Please select the best time to be reached by our Refractive Surgery Coordinator:

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*(see important note)

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