Free Evaluation for Laser Vision Correction- Koch Eye Laser Vision Centers

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566 Toll Gate
Warwick Rhode Island 02886

One Providence Place
Providence Place Mall Level 1 Suite 106
Providence Rhode Island 02903

401-732-3937

Free LASIK Laser Eye Surgery Evaluation

We can help you determine if LASIK Laser Vision Correction
is right for you. It is our pleasure to provide you with a
Free* Evaluation.
Schedule your Free Evaluation Today!

Koch Eye Laser Vision Centers is dedicated to providing you with individualized and personalized LASIK education and care at every step of the process in order to make certain that you receive the best care and achieve your personal goals.

Koch Eye Laser Vision Centers has arranged to provide you with a
FREE Evaluation Today!

Please complete the following form (ALL Fields are required items*)

First Name:*

Last Name:*

Address:*

City:*

State:*

Zip:*

Phone:*

E-mail:*

Please Answer The Following Questions

I wear

Glasses Contact Lenses
Bi focals / Reading glasses

I wear my glasses and/or contact lenses to see

Distance Near Both Distance and Near

I am interested in having Laser Vision Correction within

the next month 6 months

3 months 12 months

Please Indicate Your Acceptance.

Please contact me to schedule a

Complimentary Evaluation
A Treatment Date

Please contact me regarding

Corporate Benefit Programs
An affordable payment plan

Please include me in further informational mailings

Please select the best time to be reached by our Refractive Surgery Coordinator:

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*(see important note)