Site map   |    Français   |    Optometrists   |    Contact us    
Meet our doctors  |  The clinic  |  Our HD LasikTM and results  |  About your eyes  |  FAQs
Free Consultation
Sitemap
Français
Optometrists Login
Contact Us

Ask about our
O% financing
Free Online Consultation

Tell us about yourself:

Name Birthdate - -
First name   MM          DD          YYYY
Email Age
Phone
(Home)		 - - Phone
(Work)		 - - Ext
How did you hear about LASERVUE ?    
Why are you considering LASIK ?    
How long have you been
considering LASIK ?   		    

What are the most important factors in making your decision about LASIK ?


Tell us about your eyes :

Do you know your prescription ? Yes No
Right Eye  
Left Eye    
Has your prescription changed
since last year ?		 Yes No Don't know
How often do you wear
your glasses ? 		Full-Time Part-Time Never
How often do you wear your
contact lenses ? 		Full-Time Part-Time  
Rarely Never
Do you wear monovision contacts ? Yes No  
When did you last wear your
contacts lenses ?		   


Please have a customer service agent call me at :

- -
Laservue Clinic, lasik eye correction : 1100, Ave Beaumont, Second Floor, Montreal, Qc., H3P 3H5
Tel.: 514-738-6666  Toll Free:1-888-734-6666  Fax: 514-738-1769  Email: laservue@laservue.net