Contact Us

Questions?

Call 317-817-1085, or

toll free 888-469-3937, or

e-mail us below:

Fill out the Consultation Questionnaire below and we'll arrange a personal complimentary consultation to answer all of your questions. Please be sure to indicate your preference for day and time of consultation. We will contact you promptly with your appointment confirmation.

Consultation Questionnaire

Name:

Address:

City:

State:

Zip:

Phone (day):

Phone (evening):

Email:

Consultations are available Monday through Friday. What day and time is most convenient for you?

How would you prefer to be contacted?

Phone
Mail
Email

If phone, what is the best time to contact you?

Day
Evening

Please answer each of the following questions. (Optional but appreciated)

At what age did you begin wearing glasses?

At what age did you begin wearing contacts?

Are you :

	Nearsighted
	Farsighted
	Astigmatic
	Uncertain

Current prescription
(if known):

Left Eye
Right Eye

Age:

Type of work:

Hobbies:

What is your main motivating factor for considering laser vision correction surgery?

Do you know someone who has had laser vision correction surgery?

Yes No

Have you attended seminars or consultations at other refractive surgery practices?

Yes No

How soon are you considering having laser vision correction surgery?

	1 month
	3 months
	6 months
	1 year

How did you hear about our website?

	TV Commercial
	Radio
	Yellow Pages
	Newspaper Advertisement
	Magazine Advertisement
	Friend
	Other

Comments or Questions:

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INVISION Midwest Eye Institute
200 W. 103rd Street
Suite 1020
Indianapolis, Indiana 46290
(317) 817-1085
(888) 4 MY EYES

Map & Directions

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Patient Central

Welcome to Patient Central. Patient Central empowers you, the patient, with internet enabled tools to simplify and speed up registration, appointments, and inquiries.

Go to Patient Central

200 W. 103rd Street
Suite 1020
Indianapolis, IN 46290-1092
Map & Directions