APPOINTMENT FOR FREE CONSULTATION*

Please fill out the following form to book your free LASIK consultation. This form is only for Canadian residents.

If you have had LASIK surgery or are looking to book an appointment for another reason, please contact us at 514-738-6666 and we will be happy to assist you.

Patient Information

Appointment Information

Appointment Confirmation

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Personal Information

Title *

Mr. Ms. Mx

First Name *

Last Name *

Date of Birth *

Contact Information

Email *

Phone Number *

Postal Address *

Address (line 2) - optional

Address (line 3) - optional

Country *

State *

City *

Zip Code *

Medical Information

Do you wear contact lenses? *

Yes No

Type of contact lenses: *

Gas Permeable (RGP) Hard Soft Toric Soft/Disposable

*Denotes required field

Laservue takes your privacy seriously. All personal information provided will remain confidential. Read our privacy policy.