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LASIK Referral Program

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Department of Ophthalmology<br />

<strong>LASIK</strong><br />

Henry Ford Lasik<br />

Patient <strong>Referral</strong> <strong>Program</strong><br />

For every referral to a new patient you send to us for a laser vision correction<br />

consultation, we’ll offer you a $25 gift card to Target and a $20 discount toward<br />

non-prescription sunglasses at one of our Henry Ford OptimEyes locations.<br />

Please have your friend or family member bring this <strong>Referral</strong> Sheet to their<br />

consultation and we will send your gift to you! Thank you for your trust<br />

in Henry Ford Department of Ophthalmology.


<strong>LASIK</strong><br />

I have been referred to Henry Ford for laser vision correction!<br />

Name<br />

Address, City, State, Zip<br />

Phone Number<br />

Referred By<br />

Please call 1-800-EYE-CARE to schedule a FREE consultation and<br />

bring this <strong>Referral</strong> Sheet with you to your appointment.

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