Schedule Your Appointment Please fill out the form below to schedule your appointment. Name* First Last Email* Phone NumberZip CodeDoes Boulder seem far? We can arrange for your post Laser Vision Correction (LVC) exams nearby your home or work. Check here if you'd rather have your postop visits near your zip code. EmployerPositionHow did you hear about us?Select OneBoulderEyes WebsiteFriendOptometristInternetMarketing EventEmployerHealth FairRadioTVNewspaperDrivebyOtherPlease SpecifyWhich of the following services are you interested in? (You may choose more than one.) Eye Exam Free LASIK Screening with Tech Prescription Glasses Sunglasses Contacts Dry Eye Treatments Treatment for Reading Problems PRK LASIK LASIK or PRK Enhancement ICL Advanced Cataract Surgery Cornea Transplant Crosslinking for Keratoconus Glaucoma Macular Degeneration Botox Juvederm (fillers) Laser Facial Treatment Skin Care Products None of the Above When were you thinking of having Laser Vision Corrections (LVC)?Select OneASAP!This YearNot SureWhich of these is most important to you?Select OneSurgeon ExperienceLocationReputationCostTechnologyWould you like to apply for a low income up to a $1500 subsidy towards the cost of your laser procedure?YesNo(You can qualify if your AGI on previous year tax return is less than $25K for an individual, $40K for a family) Any out of pocket expense you incur at BoulderEyes towards glasses or contacts can be applied towards the cost of your LASIK later. There is no obligation to make any purchases. Would you like to register for LASIK Lay-Away?YesNoCan we text you appointment reminders?YesNoWould you like to be on our email list (no more than 1 email a month) for special offers?YesNoWould you like us to call you to answer questions or schedule an appointment?*I would like to schedule an exam with a doctor onlineI would like to request a free LASIK screening appointmentPlease call meDon't call, I will call you when necessary*If it has been over a year since you had an eye exam, we highly recommend you select schedule an eye exam with a doctor. (We accept most insurances for this appointment.)NOTICE: Please be sure to turn-off Pop-Up Blocker to ensure that the online schedule portal opens properlyDate*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Preferred Appointment Time*- Select -8:00 am8:30 am9:00 am9:30 am10:00 am10:30 am11:00 am11:30 am12:00 pm12:30 pm1:00 pm1:30pm2:00 pm2:30pm3:00 pm3:30 pm4:00 pm4:30 pm5:00 pm5:30 pm6:00 pm6:30 pmAre you wearing contact lenses?* Yes No Promo CodeIf you have a Promo Code, enter it here.CommentsCommentsThis field is for validation purposes and should be left unchanged.