:: The Center for Lasik Ophthalmology Consultants :: Schedule a Free Consultation ::

Consultations are held with Dr. Gailitis and Dr. Burks at our offices Monday through Friday. As part of our ongoing commitment to quality care, we work hard to ensure that you are seen promptly at your scheduled appointment time. Plan on being at our office for approximately one hour on the day of your consultation.

Note: Required fields are indicated with an *

* indicates a required field
Please reserve an appointment for me to attend a complimentary vision correction consultation on: *Day:
*Time:
Date: (mm/dd/yy):
First Name:
Last Name:
* Address me as:
Phone:
* Email:
Address:
City:
State:
Zip:
What prompted you to contact us today?
Confirm my appointment by (choose one) Phone: E-Mail: Optional Information
I am interested in: I currently wear
(Check as many as apply):

Soft Contacts Gas Permeable Contacts Glasses No Correction

I am: I wear correction:

Hosted by: Einstein Medical