LASIK & PRK Info Request

To request additional information on how to have a brighter future with LASIK, please provide the following information and email it to the address below. We look forward to helping you see clearer! 

Please provide the following and email to the address below:

  • Name
  • Address
  • Phone Number

Email your request to:  or simply fill out the appointment request form below.


The first step towards better vision is to schedule an appointment. Please contact our office by phone or complete the appointment request form below. Our scheduling coordinator will contact you to schedule your appointment.

Please do not use this form to cancel or change an existing appointment.

*Items in bold are required.
Are you a current patient?

Which office location(s) would you prefer for your appointment?

Preferred day(s) of the week for an appointment?

Preferred time(s) for an appointment?

Please describe the nature of your appointment (e.g., consultation, check-up, etc.):

Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.

Contact Us.We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form.