Laser Eye Surgery
Lasik Eye Surgery Center
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Schedule an Appointment
You can schedule your consultation using our online appointment system. All you have to do is fill in the form below and hit the submit button. You will then receive an email in 2-3 working days confirming the date and time of your consultation. No urgent/emergency appointments will be scheduled through our online appointment system. We recommend scheduling your preferred appointment date at least a week from the date of submitting the form. Having a consultation does not obligate you to have the procedure. All information given by you is strictly confidential and will merely assist us in preparing for your visit.
 
  1.
Personal Information:      
First Name:   Last Name:
 
       
       
   
Date of Birth:
(DD/MMM/YY) 		    Occupation:
 
       
       
   
Address:
 
       
       
   
Email Address:
 
       
       
   
Phone/Cell No.:     Fax No.:
 
   
       
  2.
Refractive History:
Do you wear:
Glasses Contact Lenses
 
If yes, what type?
 
For how long have you been wearing them?
 
       
       
  3.
Ophthalmic History:
Do you have any previous eye disease or surgery?
 
       
       
  4.
Refraction:
OD:  
sph cyl axis
VA          
         
OS:          
sph cyl axis
VA          
         
 
 
       
       
  5.
Appointment Schedule
At which New Vision centre would you like to schedule your appointment at?  

(If you wish to verify the address/information for one of our centers, please Click Here)
   
For when would you like to schedule your appointment?
Date (DD/MMM/YY):
Time:

 
 
       
       
  6.
Other Information:
If you have any other comments to add or information to give us, please fill in the box below:  
 
 
       
   
       
 
 
       
 

 


 
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