< HOME

> FINANCING

FINANCING

...just the way you want it!

When it comes to your well-being, vision correction may be the most important investment you'll ever make. We believe financial considerations should not be a barrier to having LASIK laser vision correction. That's why we provide financing from CareCredit.

CareCredit is a payment plan that fits your individual needs and financial circumstances. If you have been postponing an ophthalmic procedure due to budget constraints, CareCredit can help. You can schedule your procedure right away with:

• No down payment
• Low monthly payment
• Low fixed rates
• No prepayment penalty
• Interest-free options available for 12/18/24 months with approved credit* (payment required)
• Over-the-phone approval

To apply, simply call our offices at 1-888-356-0700, or visit the CareCredit website at www.carecredit.com. There are no application fees or paperwork to complete, and you can be approved in minutes.

The application process is fast and confidential, 24 hours a day, seven days a week.

* CareCredit has a plan for every budget. If your application is not approved, it will be processed for CareCreditPlus, a 12-month interest-free financing option that makes it possible for you to say YES to better vision.

Visit the CareCredit web site

ONLINE APPOINTMENT FORM

If you would like to schedule an appointment, please complete the form below and someone from our office will contact you shortly to confirm your appointment details. Please be aware that you are submitting a request only. Until you have been contacted by a representative from our office, you do not have an actual appointment. Please do not attempt to request a "same day appointment" via this web site, however same day appointments may be available. Please call our office for further details. Note: To serve you better, all fields are required for the following form unless marked as optional.

Patient Information
Salutation	--Select One -- Mr. Mrs. Ms. Dr.
First Name
Middle Initial
Last Name
Age
Date of Birth
Street Address
City
State	-- Select One -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington DC West Virginia Wisconsin Wyoming
Zip Code
Occupation
Employer
Daytime Phone
Evening Phone
Email Address
Cell Phone (Optional)
Appointment Request
Reason for Request

 

 

Thank you for your interest in Jacksoneye a member of our staff will be contact with you as soon as possible.

DOWNLOADABLE PATIENT FORMS

Clicking the link below will allow you to view and print the patient registration form. Filling this form out before arriving in our office will streamline the filing process.

Patient Information Form

Patient History Form