Laser Vision Correction Screening Evaluation
CustomVue™  Lasik
 


General Screening Information
1. Please enter your first name,
initials, or a nickname:
2. Enter your birth date
(mm/dd/yy format):		 Month:
Day:    
Year:   
3. Please enter your gender: Male:   
Female:
4. Please the approximate date of your last eye examination: Month:
Year:   

Click Here to Proceed to the Next Page: Prescription Information   

 

Click Here to Cancel the Screening and Start Over

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David W. MacMillan, M.D.     Barry E. Roper, M.D.       D. Alan Chandler, M.D.
Malcolm Magovern, M.D.    Harold A. Bernstein, M.D.    David M. Bowman, M.D.        Bryan M. Brooks, M.D.    Donald W. Lumpkin, O.D.