Schedule a Screening

Your decision to have refractive vision correction is an important one. To help you make a well-informed choice, the Laser Center for Vision offers you the perfect opportunity to receive answers to all your questions on LASIK and CK in a FREE private screening. You will be evaluated to see if you are a candidate for vision correction.

Please take a few minutes to complete the form below or if you would like to speak to one of our Laser Center for Vision assistants, please call our office at 806-356-0012. We will be happy to schedule a free screening and answer all of your questions.

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First Name:
Last Name:
Address:
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Best Time to Call:	Select Morning Afternoon Evening
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Age:
My vision information (check all that apply):  Nearsighted  Farsighted  Astigmatism  Use reading glasses
Eyewear (check all that apply):  I wear eye glasses  I wear eye glasses for reading  I wear soft contact lenses  I wear rigid/gas permeable contact lenses
Do you have a Doctor preference?  No preference Dr. Robert Gerald Dr. J. Avery Rush Dr. Bruce Weinberger
How did you hear about Laser Center for Vision? Select Website Search Engine (Google, Yahoo, MSN) Radio Television Newspaper Ad Friend/relative
Send Me Information: I want information about LASIK I want information about CK
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