Name: Laser Eye Institute
Price range: $$$$

Before visiting our website had you heard about Laser Eye Institute?

Not Familiar

Somewhat Familiar

Very Familiar

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Have you attended any consultations elsewhere?

Yes

No

What is your biggest concern regarding vision correction?

What is your time-frame for vision correction?

What do your glasses or contacts correct?

Distance Vision

Near Vision

Both

Why is vision correction a priority for you today?

Thank You

You're On The Way To Better Vision