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Complete This Form To View Our Video Library!

Please Fill Out the Following from COMPLETELY, as the staff of Park AVenue Laser Vision will be getting this form back, INCLUDING DR. CHYNN, and they cannot give you accurate advice about your situation unless they know this information. You will receive a Personal Recommendation from Dr. Chynn himself about which procedure is right for you given your age, occupation, and special concerns. Thanks!

STOP! Do NOT "click away" from this page!
It is NOT for "marketing" purposes!

This is for your FREE INTERNET CONSULTATION WITH DR. CHYNN HIMSELF! Dr. Chynn (Harvard + Columbia-trained, 13,000 cases, perfect record, 1st surgeon in NYC to get LASIK himself, MENSA member) will PERSONALLY REPLY to your questions! So fill this form out completely so Dr. Chynn has complete information to answer your questions specifically!

Dr. Chynn needs this information to say how long your recovery will be, and whether you need MonoVision so you won't need readers, and what your chances of 20/20 will be.

 

Your Company information lets us know if you can save money with a Corporate Discount Program, and what your visual needs are. Your Medical Insurance may also pay for part of it!


Telll us about any particular concerns you have, or if you have a previous eye history, particularly any type of prior eye surgery, so Dr. Chynn himself can answer your questions!

Your contact information will NOT be saved in a database, you will NOT be spamed, and your information will NOT be sold. So don't worry about giving us as complete info. as possible!


RX: Your Prescription will help us tell you what your odds of seeing 20/20 (or better) afterwards are, and whether you are withing our parameters for safe treatment.

Enter your first name here
*
You Must provide a valid email, Dr. Chynn will send you the gallery link to the address given
*
Enter your ten digit phone number (include area code, no spaces or slashes)
*

So we can recommend the correct procedure for your age.
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To tailor your procedure to your visual needs!

Your medical (not vision) insurance, so we can offer you an insurance discount!.

So we can offer you a corporate discount!


Comments/Concerns:

I have my eyeglass or contact lens
 prescription handy.
Give an approximation: (glasses/contacts, include the +/- sign, i.e., -3.50)
Give an approximation: (glasses/contacts, include the +/- sign, i.e., -3.50)