Pepose Vision Institute - Patient Information Form

Online Only Offer
Complimentary Consultation for Raindrop or KAMRA Inlay
Offer Ends July 31st 2019


You are not qualified for this procedure if you have had previous LASIK or Cataract Surgery.
The procedures advertised are fully elective and are not covered by most insurance plans.
The consultation is free provided you use this form to book your appointment. After the consultation you'll have the choice to proceed to the next step in the evaluation process. If you proceed you'll be asked to pay a $200 deposit against the full price of the procedure or apply for Care Credit. Terms and Conditions
Medical Conditions
You may not medically qualify for this procedure if you have have any of the following conditions:
• Glaucoma
• Histoplasmosis
• Keratoconus
• Strabismus
• Macular Degeneration
• Optic Nerve Disease
• Retinal Detachment
We attempt to answer every question within 24 hours. If you ask during the weekend it might take longer. Please look for the answer in your email.
Complimentary Consultation