The LASIK Vision Institute
1-877-274-1797
      
     
THE LASIK VISION INSTITUTE, LLC
NOTICE OF CANCELLATION FOR PENNSYLVANIA RESIDENTS

Pennsylvania residents may cancel their scheduled surgery at any time without any penalty or obligation.

If you cancel, any payment that you made to The Lasik Vision Institute in connection with your financing the cost of your surgery will be returned to you within 15 days following of The Lasik Vision Institute’s receipt of your cancellation notice.   To cancel your surgery, mail or deliver a signed and dated copy of this cancellation notice or any other written notice to The Lasik Vision Institute at the location where your surgery was scheduled to take place.

I hereby cancel this transaction.

 
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Date Patient’s Signature

 

 

 

 

 

 

 

 

 

 

 

      

*Prices based on prescription: up to -1.25 $299, -1.50 to -2.0 $899, -2.25 & up inclusive of all hyperopic &/or patients with greater than -1 diopter of astigmatism $1299. Candidacy determined by an independent doctor located within or adjacent to the LASIK Vision Institute's facility. All procedures performed by an independent surgeon. Comfort plugs and assurance plans available at additional cost. Other conditions may apply. May not be combined with other discounted offers.

Florida Residents: Candidacy determined by an independent doctor located within The LASIK Vision Institute's facility. Free evaluation does not include charge for candidacy determination; fees paid for candidacy determination will be deducted from price of procedure. The patient and any other person responsible for payment have a right to refuse to pay, cancel payment, or be reimbursed for payment for any other service, examination or treatment which is performed as a result of and within 72 hours of responding to the advertisement for the free discounted fee or reduced fee service, examination or treatment.

Financing Offer: Offer subject to credit approval by GE Money Bank. Only applies to purchases of $1000 or more made between 7/1/10 and 12/31/2013. No finance charges will be assessed if (1) purchase amount is paid in full by 12/31/2013, (2) all required monthly payments are paid when due, and (3) account balance does not exceed approved credit limit. Interest will be charged to your account from the surgery date if the purchase amount is not paid in full by 12/31/2013 or if your account is otherwise in default. Any payments received in excess of required monthly payments will be applied to balance of purchase price, thereby reducing the benefit of this promotion. GE Money Bank's standard terms apply to non-promotion purchases, optional charges and existing accounts. As of 2/6/2008, variable APRs: 21.98% and APRs on accounts in default: 26.99%. Minimum finance charge is $1.50