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The eyes have it.

Stirling Eyecare & LASIK Center
Appointment Request

Please fill out form below to make appointment (please allow 24 hours for response) or call us for faster service.

Patient information:

Patient name:
Home phone:
Work phone:
Email address:
Is this your first visit?
What is the reason for appointment?
Concerns, if any:
Please enter 3 preferences of day and/or time (eg - Mon morning, Mon 10am, 10am any weekday, 2pm this weekend, etc)
1st preference:
2nd:
3rd:
How do you prefer to be contacted for confirmation?

 

Click here to download Patient Information Form.

Click here to download Medical History Form.