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Schedule a LASIK Screening

If you would like to set up an appointment to schedule a free LASIK screening,
please fill out the form below.


First name Last Name
Street Address
City   State   Zip Code
E-mail address

Telephone Number in this format - 717-757-2020

Age
Do you wear glasses? YESNO
Do you wear contact lenses? YESNO
Please select the day you would like to schedule your FREE screening

(Calendar provided for your convenience)

Today is

After clicking the button below, your information will be sent to our office and we will contact you to schedule your screening
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© 2000 Christianne Schoedel, M.D.