Schedule Your Appointment | Beyer LASIK / Boulder Eyes

Name*

First Last

Email*

Phone Number

Zip Code

Does Boulder seem far?

We can arrange for your post Laser Vision Correction (LVC) exams nearby your home or work. Check here if you'd rather have your postop visits near your zip code.

Employer

Position

How did you hear about us?

Please Specify

Which of the following services are you interested in? (You may choose more than one.)

When were you thinking of having Laser Vision Corrections (LVC)?

Which of these is most important to you?

Would you like to apply for a low income up to a $1500 subsidy towards the cost of your laser procedure?

Yes
No

(You can qualify if your AGI on previous year tax return is less than $25K for an individual, $40K for a family)

Any out of pocket expense you incur at BoulderEyes towards glasses or contacts can be applied towards the cost of your LASIK later. There is no obligation to make any purchases. Would you like to register for LASIK Lay-Away?

Yes
No

Can we text you appointment reminders?

Yes
No

Would you like to be on our email list (no more than 1 email a month) for special offers?

Yes
No

Would you like us to call you to answer questions or schedule an appointment?*

I would like to schedule an exam with a doctor online
I would like to request a free LASIK screening appointment
Please call me
Don't call, I will call you when necessary

*If it has been over a year since you had an eye exam, we highly recommend you select schedule an eye exam with a doctor. (We accept most insurances for this appointment.)

NOTICE: Please be sure to turn-off Pop-Up Blocker to ensure that the online schedule portal opens properly

Date*

Preferred Appointment Time*

Are you wearing contact lenses?*

Yes
No

Promo Code

If you have a Promo Code, enter it here.

Comments

Email

This field is for validation purposes and should be left unchanged.