The form to the right is for prospective LASIK patients; for all other patient questions,please call 713-365-9099.

To preregister for your office visit, click below.


How did you hear about us? (check all that apply)
Referral from Doctor of Optometry
Friend/Family Member
Houston Links Magazine Ad
KILT-AM (610 AM) Radio Ad
KTRH-AM (740 AM) Radio Ad
TexasLasik.net website
Doctorwhitsett.com website
Google search
Other:
   
Name :
E-Mail (required) :
Address :
Apt.# :
City :
State :
Zip Code :
Phone :
Contact me to schedule a FREE LASIK consultation Yes No
Age :
What is your refractive error? (Check appropriate boxes)
Nearsighted (Myopia) Farsighted (Hyperopia) Astigmatism
Your Vision Concern / Question :
Comments :