Welcome to The LASIK Vision Institute’s New and Improved Referral Rewards Program!

The program now features the opportunity to receive up to $100* per referral

Our NEW & IMPROVED Share the Vision Program provides a reward for spreading the good word about The LASIK Vision Institute.™

1. Complete the below form with the referral’s and referrer’s contact information.

2. For each referred friend or relative who has laser vision correction with us, we’ll send the referrer a thank you check: $50 for the first referral...$75 for the second referral...and $100 for every additional referral — NO LIMIT!

*$50 for the first, $75 for the second, & $100 for every additional referral

To PRINT Referral Reward Cards, click here.

Your Information:
First Name
Last Name
Email
Phone
Your Surgery Location	Promotion not available in CA, FL, TN, or WI.
Your Surgery Date	i.e., 00/00/00 (mm/dd/yr)
Your Patient ID#	i.e., 012-3456789
The Person Who Referred You: Full name and mailing address are needed for reward payment and delivery.
Referrer's First Name
Referrer's Last Name
Email
Phone
Address
City
State
Zip Code
Promotion not available in CA, FL, TN, or WI.
Contact rewards@lasikvisioninstitute.com for additional information.