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HOURS (CST)
Mon. - Fri. : 7 am to 7 pm
Sat. : 8 am to 4 pm
1-877-507-4448

Request an Appointment

Request an appointment date and time
by filling out the following information.
Appointment times are subject to availability.
We will do our best to accommodate your request.
Our office will contact you to confirm your appointment.
If this is a medical emergency, please call 911.

*First Name:	:
*Last Name:	:
Address:	:
*City:	:
Zip:	:
* Age	:
*Phone	:		Cell Phone
*E-Mail	:
Plan Sponsor	:	Health Benefits Plan, Farm Bureau, Labor Union, Employer, Etc.
Contact Lens Wearer?	:	Yes No
Appointment Information
State	:
Office Location	:
Requested Date	:
Appointment Date must be at least 1 week from today*. We will be contacting you shortly to confirm your requested appointment date and to collect your $50 refundable deposit. If you would prefer an earlier appointment date please call us to schedule.
Requested Time of Day	:

Other Comments, Questions, or Special Instructions

"This is a wonderful program. I probably would not have even considered LASIK surgery if it wasn't for QualSight. I have no regrets and wish a program like this would have been available when I was younger."

-- Michele B., Kentucky

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1-877-507-4448

Plan Sponsor Information

Request an Appointment

Schedule a FREE doctors exam at our doctors' offices today

Schedule Online

When would you like to get LASIK?