Name:Date of Procedure: //

Type of visit and/or procedure performed for you by Dr. Carlson

Please share about your experience at Claris Eye Care & Surgery and the Phillips Eye Institute (if applicable):

Please share with us an example of how this surgery has impacted your lifestyle. Are you able to participate in activities/hobbies that prior to surgery, you were not able to or were more difficult for you?

What could we do to improve your experience at Claris Eye Care & Surgery?

Would you allow us to share the results of your procedure on our website and facebook page www.facebook.com/clariseyecare, so that other patients considering similar procedures with Dr. Carlson can read about your success? We would list your comments along with your first name and the date of the procedure. If you would like us to share your results with prospective patients, please fill out the authorization form below.
Thank you!