Appointment Request


Please fill out the fields with your preferences  and we will contact you regarding  the next available appointment time for your FREE LASIK Eye Exam. 

Name:
Email Address:
Phone Number:
Best time to call:
Location
Your question or comment:
What day(s) of the week work best for you? MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
What time of day works best for your exam?
How do you currently correct your vision? Glasses
Contacts (Soft)
Contacts (Toric)
Contacts (Rigid/Gas Perm)
Reading Glasses
Nothing
Would you like us to schedule your exam if one is available at the requested time? Yes, schedule exam and confirm by email
Yes, schedule exam and confirm by phone
No, please call before scheduling

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