Schedule A Consultation If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required To request a Cataract Surgery or LASIK Refractive Surgery Appointment, please complete the form below. We will contact you to confirm your appointment date and time. Contact Information Your Full Name: * Address 1 City 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 / Post Code Your Phone Number: * Your Email * Appointment Information What type of appointment do you wish to schedule? Cataract SurgeryLASIK SurgeryOther eye problems What are your preferred days & times for an appointment?