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PPC Self-Eval

Self-Evaluation

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Welcome

Hi there, please fill out our free self-evaluation to see if you might be a good candidate for LASIK.

9Questions

1

Select your age group* This field is required

Under 18

19-39

40-59

60+

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2

What do you usually wear?* This field is required

Glasses

Contacts

Reading Glasses

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3

Without my glasses and contacts* This field is required

I have trouble reading and seeing things up close

I have trouble driving and seeing things that are far away

I've been told that I have astigmatism

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4

Do you have any of the following?* This field is required

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5

Can we get your name?* This field is required

First Name

Last Name

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6

What is your phone number?* This field is required

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7

What is your email?* This field is required

[email protected]

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8

The best way to contact you is?

Phone

Email

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9

I consent to receiving email marketing communications.* This field is required

YESNO

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10

Status

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11

Referrer

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Valued Patient,

Patient safety – and the safety of our team members – is always our #1 priority at Rosenbaum Eye & Laser Center. Information about COVID-19 is changing on a daily basis and we are continually reassessing how our practice should respond to increased risks.

At this time, our practice is restricting non-essential appointments and postponing elective surgery for patients. This means that if you have a regular eye exam or any other type of appointment or scheduled surgery that can be safely delayed, we shall be rescheduling for a later date. If our staff has not already contacted you regarding your appointment or surgery, please call us directly at 517-393-2020 to verify if your appointment is still on or a possible rescheduled date for your surgery.

At this time, we will still accept patients into our facility with urgent problems. However, if you do have an urgent problem but are experiencing a respiratory illness or other symptoms of the coronavirus, we ask that you please contact us prior to coming into our facility. We are committed to helping our patients and we are acting to reduce the risk of infection to keep all patients and our staff healthy.

Please understand that we are all trying to navigate the best ways to handle this dynamic situation. We are receiving updates from the American Academy of Ophthalmology as well as Centers for Disease Control so we can make the most educated decisions on how to provide or restrict patient care. We appreciate your patience as we all work together through this situation. We shall continue to post updates, as they are available.

Please reference the following sites for the most accurate information regarding COVID-10:

Centers for Disease Control & Prevention: CDC.gov
World Health Organization: WHO.int

Thank you for understanding and please call us at 517-393-2020 if you have any questions.

Stay healthy.

Sincerely,

Doctors and Staff at Rosenbaum Eye & Laser Center

Main Phone: (517) 940-4140
Now Taking LASIK Calls from 8:30AM to 10:00pm M-F & 12:00PM -6:00PM Sat & Sun
LASIK Hotline: (517) 753-2120

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