Schedule Your Refractive Procedure

 


 
 

   








 



 
 


You can schedule your C-lasik or other Refractive Procedure by filling up the from below. Examination of your eye is to be done at least a day before the procedure and a follow up one day after the procedure i.e. a total of three days. C-lasik laser is done on all working days i.e Monday to Saturday. Please let us know your preference for the date of examination of your eyes and also the date on which you would like to undergo Lasik. We would try to accommodate you on the dates requested and would send you an e-mail of confirmation or else we would suggest alternative dates if the requested dates are not available.
 

Please fill up the form below :

*Name

*Age
Sex
Postal Address
Phone Number
*E-mail Address
Fax Number
Consultation Date (Sunday Closed)
Year
Date for Refractive Procedure
Year
  Current spectacle number (Required for better evaluation of Your details)
Right Eye Left Eye
  Sph. Cyl. Axis Sph. Cyl. Axis
 Distance:
Reading: NOT REQUIRED
   
 
* - Mandatory Fields

  

 

 

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