fbpx

Form

Demographic

  • Please enter a number from 0 to 100.
  • Emergency Contact Person's Number
  • Emergency Contact Persons's Relation
  • Be Specific so we can Assess your Visual Needs at Work and Leisure & Set up Corp. Discount & save $500/company
  • no abbreviation
  • If you heard about us via Friend/Patient/Doctor please leave their name. If you heard about us via Google please write search term used. Leave blank otherwise.
  • Name and phone/email
  • MEDICAL INSURANCE INFO. (REQUIRED FOR ALL PATIENTS): To offer a Medical Credit for LASEK and for Office Visits/Second Opinions we must confirm that we accept your plan, that it’s active, and if you need a Referral to see a Specialist. We also need this so we can bill your insurance for punctal plugs to treat Dry Eye Syndrome & speed healing after surgery. We will bill only with your permission. We will accept as full payment whatever your insurance pays—unless it is $0 because you didn’t get a referral, or if you’re inactive, or if your referral isn’t used up. Call Kaye at PM Medical Billing at (516) 922-1561 if you have
  • SECONDARY INSURANCE (Medical or Vision): CAN HELP COVER MORE OF YOUR PROCEDURE COST:

Please fill out the form

  • Please don't worry - Your information will NOT be automatically added to our database.

  • This field is for validation purposes and should be left unchanged.

Already Leaving?

If you are unsure about what procedure to choose or need more information please feel free to ask Dr.Chynn one question.

We are the only center in the country allowing you to ask our doctor a question, and he will answer personally.

Why Haven’t You Gotten Laser Vision Correction Yet?

Dr. Chynn graduated from Dartmouth + Columbia + Harvard + Emory + NYU and has been featured on CNN, ABC, NBC, CBS, Discovery Channel & in the NY Times & Wall St. Journal

He’s performed 1,000 PRKs, 5,000 LASIKs, 10,000 epiLASEKs, 15,000 LASEKs – more than any surgeon in the US

He got LASIK in his right eye & LASEK in his left eye, so is UNIQUELY qualified to tell you the +/-‘s of BOTH procedures – from BOTH a Surgeon’s & Patient’s point-of-view!

Ask Dr.Chynn Your Questions Or Concerns!

There was a problem with your submission. Please review the fields below.

  • Please don’t worry – Your information will NOT be automatically added to our database.

  • This field is for validation purposes and should be left unchanged.