DiStefano Medical Spa

Contact Us

Ready to take the first step in getting out of glasses and contacts?  Enter your information here and a member of our staff will contact you to set up your free, no obligation consultation.

Online Contact Form
Name: *
Address:
City:
State:
Zip:
Home Phone:
Work Phone:
Fax:
Email: *
Date of Birth: mm/dd/yy
Does the  
patient wear: 		Eye Glasses
Contact Lenses S/H/GPI
Is the patient:

 Nearsighted
 Farsighted
 Astigmatic
 Uncertain

How did you hear about our website?
  Radio
KZ 106/WSKZ FM
GT108/Oldies 107.9/
WOGT FM
WGOW AM - Newstalk 1150
WGOW FM - Talk 102
Other - please state
Newspaper
  Television
Channel 3/4
Channel 9/10
Cable
Other - please state
Word of Mouth
Current Patient
Comments or Questions:

 

Already scheduled?  Download our new patient paperwork here.  Fill it out and bring it to your appointment, along with your medical insurance card and photo ID, to reduce waiting time!

New Patient Forms Go

 

Doctor Biography - Vision Correction Procedures & Consultation - Frequently Asked Questions - Seminars - Financing Options - Testimonials
Map and Directions - Ask the Doctors - Ready to Schedule? - New Patient Forms - Site Map

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Content © 2010 Deborah R. DiStefano, All rights reserved.		 FlexMD Website