250 Fame Ave Suite 225
Hanover, PA 17331
Note: Do not use this form for emergency purposes.
To receive our great Laser Vision Correction Informational Packet please include your mailing address below, thank you.
Are you at least 18 years old?YesNo
Do you wear:GlassesContactsBothNeither
Have you been considering LASIK surgery?YesNo
Have you been considering Dry Eye Treatment?YesNo
Have you been considering cataract surgery?YesNo
Have you had any major fluctuations in your vision in the past year?YesNo
Where did you read/hear about us?FriendRadioTVNewspaperMagazineSearch EngineFacebook
Yes, I would like to receive more information from the May Eye Care Center.
2 + 0 = ? Please prove that you are human by solving the equation *
Call today for a FREE LASIK
Programming, Design and Hosting by PracticeDock, ©