Laser Vision Correction at One EyeCare

$1000 off LASIK both eyes for surgery

Hurry, this offer ends soon!

Dr. Jennifer Wu is OC's premier laser vision correction doctor for men and women.

Please complete the form to schedule your
free consultation.

What age group are you in?

18 - 24

25 - 44

45 - 55

Over 55

What are you hoping to accomplish with Laser Vision Correction treatment?

No longer have to wear corrective lenses

Correct Nearsightedness

Correct Farsightedness

Astigmatism

Other

Do you currently wear glasses or contacts?

Yes, glasses

Yes, contacts

Both, contacts and glasses

No

Has your glasses and/or contact prescription been stable for 12 months?

Yes

No

Do not know

No longer have to wear corrective lenses

Correct Nearsightedness

Correct Farsightedness

Astigmatism

No longer need reading glasses

Other

Do you currently wear glasses or contacts?

Yes, glasses

Yes, contacts

Both, contacts and glasses

No

What are you hoping to accomplish with Laser Vision Correction treatment?

No longer have to wear corrective lenses

Correct Nearsightedness

Correct Farsightedness

No longer have to wear contacts

No longer need reading glasses

Other

Do you currently wear glasses or contacts?

Yes, glasses

Yes, contacts

Both, contacts and glasses

No

What are you currently using for near vision?

Over-the-counter readers

Bifocals/progressives

Multifocal contacts

Monovision

Nothing

Why do you want a consultation?

To Help With Near Vision

To Help With Distance Vision

Both

What are you currently using for near vision?

Over-the-counter readers

Bifocals/progressives

Multifocal contacts

Monovision

Do you have any issues in the following? Check all that applies.

Driving at night

Reading small print

Playing golf

Applying make-up

Have you been told you have cataracts?

Yes

No

Are you interested in cataract surgery?

Yes

No

What is your first name?

Our office is located at:
3033 Bristol St, Ste 123 | Costa Mesa, CA 92626

Do you live or work within 25 miles of our office?

Yes

No

What is your last name?

Our Patient Coordinator will be reaching out to you to schedule your consultation.

What is your cell phone number?

Also, we will send you an email confirmation for your consultation request.

What is your best email address to receive this notification?

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

$1000 off LASIK both eyes for surgery

Hurry, this offer ends soon!

What age group are you in?

What are you hoping to accomplish with Laser Vision Correction treatment?

Do you currently wear glasses or contacts?

Has your glasses and/or contact prescription been stable for 12 months?

Do you currently wear glasses or contacts?

What are you hoping to accomplish with Laser Vision Correction treatment?

Do you currently wear glasses or contacts?

What are you currently using for near vision?

Why do you want a consultation?

What are you currently using for near vision?

Do you have any issues in the following? Check all that applies.

Have you been told you have cataracts?

Are you interested in cataract surgery?

What is your first name?

Our office is located at: 3033 Bristol St, Ste 123 | Costa Mesa, CA 92626

Do you live or work within 25 miles of our office?

What is your last name?

Our Patient Coordinator will be reaching out to you to schedule your consultation.

What is your cell phone number?

Also, we will send you an email confirmation for your consultation request.

What is your best email address to receive this notification?

Our office is located at:
3033 Bristol St, Ste 123 | Costa Mesa, CA 92626