Free Evaluation

To request a free evaluation for LASIK vision correction, simply complete the form below and pick a convenient day and time. Our staff will be in touch with you to confirm or offer an alternate time should your first request not be available.

Thank you for your interest in DiStefano Eye Center, and you are welcome to call us at 423-648-3937.

First Name (required):*
Last Name (required):*
Email (required):
Phone:
Address:
City:
State:
Zip:
Preferred Location:*
Schedule:
I Would Like More Information On The Following:
I Would Like More Information On The Following:
Other (Please Specify):
Staff Member:
DiStefano Eye Center has my permission to contact me and I can rescind this permission at any time:
Permission:
Questions or Comments:
Recaptcha Word Verification: