CONTACT US Schedule Today Contact Us 1 (800) 537-8054 Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastEmail *Phone *Comment or Message *Submit Take Our Lasik Quiz! Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastPhone Number *What is your Age? *Under 2121-4041-6970+Are you interested in seeing well up close (ex. reading) without glasses? *It's very important to me NOT to wear reading glasses.It is NOT important to me. I don't mind wearing reading glasses to see things up close.Do you know your visual prescription? *YesNoDo you have dry eyes?YesNoEmail *Do you have trouble seeing far away or up close? *Up CloseFar AwayUp Close and Far AwayWhat is your current method of vision correction? *GlassesContact LensesContact Lenses and GlassesHas your prescription been stable over the past two years? *YesNoDo you have any autoimmune diseases, collagen vascular diseases, diabetes, or are immunocompromised?? *YesNoDo you have corneal thinning (keratoconus), corneal scarring, glaucoma, cataracts, herpetic eye disease, or retinal disease? *YesNoA surgical consultant from Little Rock Eye Clinic will contact you with your results. Would you prefer we reach you by phone or email? *PhoneEmailHow did you First hear about us? *GoogleFacebookTVNews ArticleFriend or Family MemberOtherCaptcha to Prevent Spam *What is 7+3? Please answer before submitting.Submit
