FREE LASIK Online Form

Howerton Eye Clinic has been in Austin for over 25 years. Central Texas has afforded Dr. Howerton the pleasure of calling many residents his patients! The Howerton Eye Clinic would like to give back to Austin! Therefore, Howerton Eye Clinic will be giving one Central Texas Resident free LASIK this fall.

Do you want the freedom of life without the inconvenience of glasses or contact lenses? Fill out the following application and write a short essay telling us why you think you deserve a free LASIK procedure. Please review the contest rules before submitting your short contest essay.

Please fill out all required fields. Howerton Eye Clinic will not discriminate on the basis of gender, race, ethnicity or creed.

First Name*:
Last Name*:
Date of Birth:
Gender:	Male Female
Address:
City:
State:
Zip Code:
Occupation:
Daytime Phone:
Evening Phone:
Best time to call:
Email Address*:
Do you wear:	Glasses Contact Lenses Both
If you wear contact lenses, what type of contacts do you wear?

Do you have:	Nearsightedness Farsightedness Astigmatism
Have you had LASIK or any other vision correction procedure? If yes, please describe.

Do you know your prescription? If yes, what is it?

	(If you do not know your prescription, it can usually be found on your on contact lens box or obtained from your optometrist.)
Would you be willing to appear in advertisements for Howerton Eye Clinic?
	Yes No
Essay:
I have read and accept the terms of the contest.
Contest Terms Only one entry per person. Essay must be submitted via the Howerton Eye Clinic website or in person at Howerton Eye Clinic by noon on July 20, 2007. Contestant must between the ages of 25 and 55. Contestant must be nearsighted, farsighted or have astigmatism. In order to assure that all finalists will be candidates for LASIK or a related laser vision correction procedure, contestants must agree to an examination if contacted for one. A dilated eye exam will be required. Only complete entry forms will be considered. Contestants must be residents of the state of Texas. Howerton Eye Clinic cannot guarantee the final result of laser vision correction. All reasonable efforts will be made to assure an excellent final result. Howerton Eye Clinic respects the privacy of its patients and will not share personal information of the contest entrants with third parties. Employees of Howerton Eye Clinic, PA and Austin Refractive Surgery, Ltd and their immediate family members are not eligible to participate.


	Call for your free consultation: 512.444.0701 or 1.800.323.3937 Note: Free consultation for Refractive Surgery only. or Email US

For experience you can clearly see! Howerton Eye Clinic
2610 South IH 35, Austin, TX 78704
(Just South of Oltorf, on the southbound service road)

Located in the Seton Family of Doctors at Hays building,
5103 Kyle Center Dr., Kyle TX. 78640.
Contact us at 800-323-3937 to schedule an appointment.

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This Site Does Not Provide Medical Advice. The content provided in these web pages is for information purposes only. It should not be used as a substitution for professional medical advice. None of the materials presented may be relied upon for any medical, diagnostic or treatment reasons whatsoever. Any person reviewing the materials presented herein should obtain specific medical advice and answers to specific medical questions by a qualified LASEK surgeon in Austin.