Free LASIK Evaluation
Please fill in the information below so that we can contact you to set up a free LASIK screening at one of our Sarasota or Bradenton offices.

You will receive an opportunity have questions personally answered by one of our LASIK surgeons and find out if you are a candidate for the procedure.


NAME: *
DAYTIME PHONE: *
EMAIL ADDRESS: *
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THE PATIENT AND ANY OTHER PERSON RESPONSIBLE FOR PAYMENT HAS A RIGHT TO REFUSE TO PAY, CANCEL PAYMENT, OR BE REIMBURSED FOR PAYMENT FOR ANY OTHER SERVICE, EXAMINATION, OR TREATMENT THAT IS PERFORMED AS A RESULT OF AND WITHIN 72 HOURS OF RESPONDING TO THE ADVERTISEMENT FOR THE FREE, DISCOUNTED FEE, OR REDUCED FEE, SERVICE, EXAMINATION, OR TREATMENT.