Lasik Cheshire Connecticut - Precision Lasik Group Connecticut Contact Us Form

Call Us

You may call our offices to ask questions and schedule a free consultation, or use our Online Contact Form below to send us a message (we will respond shortly).

Toll Free (in Connecticut):	(877) 944-4454
Local or Cheshire Area:	(203) 250-9800

Online Contact / Screening Information

Please take a moment to fill in the following fields. This information will assist us to better determine your laser vision correction candidacy and to help answer any questions or concerns you may have. Thank you! Precision Staff.

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Age:		Gender:	Male Female

Do you wear: (Check all that apply)			Glasses Contact Lens Readers

What age did you begin wearing lenses:

The patient is: (Check all that apply)			Nearsighted Farsighted Astigmatic Uncertain

Current eye doctor:

Have you ever been screened for laser vision correction candidacy before?			Yes No

Are you interested in: (Check all No Obligation interests that apply)			Attending an evening seminar? Scheduling a brief, complimentary LASIK screening? Scheduling a complete LASIK Examination? Having information mailed to your home address? Applying for patient financing?

How long have you been considering the LASIK alternative?

How did you hear about our website?

Comments or Questions

If you are from one of the following locations in Connecticut: Cheshire, Hamden, Danbury, Brandford, New Britain, Waterbury. Call us Toll Free at 1-877-944-4454

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