Appointments

Name: Laser Eye Institute
Price range: $$$

Complete the below form to request an appointment. Our team will contact you to schedule the appointment.

Appointments are not valid until you speak with our team.

"*" indicates required fields

First Name*

Last Name*

Phone Number*

Email Address*

Preferred Contact Method*

Birthday*

What Best Describes Your Appointment?*

Are You A New Patient?*

Medical Insurance Provider

Vision Insurance Provider

Preferred Date*

Preferred Time*

Additional Notes