Free Lasik Drawing

If you would like to call us our phone number is 303.393.0347. We are happy to answer any of your questions or you can schedule a complimentary (free) consultation to see if you are a candidate for Laser Vision Correction.

If you are interested in registering for the drawing for a free Laser Vision Correction procedure* by Dr. Levinson, please fill out the following form. Items with a star (*) must be completed in order to be eligible for the drawing.

Name (required)

Email (required)

Phone (required)

Address

City

State

Zip

Do you have any questions?

Do you know if you are a candidate for the procedure?
 Yes No

Do you wear glasses, contacts, or both?
 Contacts Glasses Both

For distance or near?
 Distance Near Both

Part time or full time?
 Part time Full time

Do you know your prescription?

What's been holding you back?

May we contact you regarding a complimentary consultation?
 Yes No

When do you want to have LVC?

How did you hear about Dr. Levinson's website?
 City Search Flyer Doc Shop Patient/Friend Postcard Search engine Seminar Health Fair Event Other