1-800-20HAPPY

OptiVision Laser Centers

Do you want to visit OptiVision for a free, no-obligation consultation?
Call 1-800-20-HAPPY to book your appointment today at one our three convenient locations!
If you have already booked a consultation with us please print this form, fill it out and bring it with you to your appointment

If you want more information, please fill out the following form and one of our qualified technicians will contact you to ensure all of your questions are answered. Be sure to include your first and last name, your e-mail address and phone number. Your information will NOT be sold to outside individuals or businesses for telemarketing.

Do you think you're a candidate for laser vision correction surgery? To be eligible for the surgery, you must meet the following criteria: Over 18 years of age Mild to severe farsightedness, nearsightedness or astigmatism Not pregnant or nursing Stable vision Healthy eyes and corneas Name: Phone: Best Time to Contact: Address: City: State Choose a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip: E-mail: Are you:   Nearsighted? Yes No Farsighted? Yes No Astigmatic? Yes No Do you wear glasses or contacts Yes No What's your prescription? (optional) Right Eye: Left Eye: When do you wear corrective lenses? All the time Reading Driving Only at night Do you have any questions or comments? How did you hear about us? Search Engine Magazine or Newspaper* Friend/Family Member Direct Mail Typed in Web Address VISX Television Radio Yellow Pages Other* *Other: *If magazine or newspaper, which one?