Contact Us

Colorado Springs & Pueblo, CO

Your decision to have corrective vision surgery, whether it be LASIK or REAL Vision, is an important one. To help you make an educated choice, you can set up an appointment for a FREE consultation with a member of our team to evaluate your current prescription and discuss your expectations to see which treatment is right for you.

We appreciate your interest! Please fill out the form on the right and we will schedule your consultation. We will also send you our FREE LASIK VIDEO if you request it. Your personal information will be kept strictly confidential. If you are requesting a free consultation appointment, you can save time by printing out the Patient Consultation Forms below and bringing the filled out forms with you to your appointment.

Click here for PATIENT CONSULTATION FORMS

Buckley Vision Institute is located in the heart of Colorado Springs on Union Blvd just a quarter mile north of Fillmore. For a map and detailed directions just click below.

Click here for a Map to Buckley Vision Institute

*First Name:
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Address:
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Procedure:	select one General Eye Care Lasik Vision Correction REAL Vision Correction
How would you like to be contacted Email Phone Best Time to Contact 8AM 9AM 10AM 11AM 12AM 1PM 2PM 3PM 4PM 5PM Receive our FREE LASIK video Yes No VHS CD How Did You Hear About Us? Please select one Radio Commercial Television Commercial Newspaper or Other Print Ad Corporate Partner Referral (Friend, Family or Co-Worker) All About Vision Website LASIK MD (EyeVolume) LocateADoc Website Google or Other Search Engine Other Source? Please select where you heard about us. Which Radio Station? KBIQ 102.7 Christian KKCS 101.9 Country KKLI 106.3 (K-Lite) KKFM 98.1 Classic Rock KKMG 98.9 (Magic FM) KIBT 96.1 (Request Line) KRDO 95.1 (The Peak) KSKX 105.5 Jazz KSPZ 92.9 Oldies KVOR 740 Talk Radio KVUU 99.9 (K Vue) Unknown Which TV Station? KOAA Channel 5/30 (NBC) KKTV Channel 11 (CBS) KRDO Channel 13 (ABC) Fox News Ch 38 Channel 21 Fox 21 & UPN57 Unknown Which Print Source? Gazette Gazette (Insert) Independent Military Newspaper Magazine Unknown No further selection needed.
What type(s) of vision correction do you currently use? (Check all that apply): Glasses Bifocal Glasses Reading Glasses Gas Permeable Contacts Toric Contacts Soft Contacts
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The Health Insurance Portability and Accountability Act of 1996 requires that each medical provider include a "Notice of Privacy Practices" be posted on their web site. You can view and print our Notice of Privacy Practices by clicking below:

Click here for our Notice of Privacy Practices