Great News!

Based on your answers, you appear to be a good candidate!

We would like to gift you with a $1000 Gift Certificate redeemable on any procedure at ClearSight.

Simply complete the rest of the evaluation below to find out which procedure is right for you and it will be sent to you immediately!

Is your current age range:
45-4950-5960 and older

What types of eyewear do you use now? (Check all that apply)
Contact LensesPrescription EyeglassesBifocalsDime Store Reading GlassesNone of the Above

Which statement best describes your need for glasses or contact lenses?
To see objects and text up closeTo see things far awayTo see clearly at all distances

Please fill out the information below so we can email you your results, and your $1,000 Gift Certificate!

First Name*

Last Name*

Email Address*

Phone Number

Birthday* (knowing your age helps us provide more accurate recommendations)

How may we help you learn more? (Check all that apply)

I'd like to schedule a free consultation

I have some questions. Please CALL me to chat!

Please send an infopak to the following address:

How did you hear about us?*