FREE EXAMINATION REGISTRATION
As our thanks to your for stopping by our website we would like to offer you an opportunity to win a free eye examination.  By completing the registration form below you will be entered into a weekly drawing for an examination, it's that simple.  

For those of you who like rules, we have just a couple below.  No tricks, no gimmicks, and nothing to buy.  We are offering this promotion to introduce you to our practice.  It's our way of letting you know that old fashion eye care with today's technology does exist.

We will NOT contact you by phone or send you literature via email or postal system unless we have your permission.  Information provided to us is keep confidential and is sent to us via a secured server.

THE RULES

bulletComplete the registration form below (simple enough).
bulletOnly one entry per person each week.  This means each family member CAN enter on a separate form.
bulletThe eye exam is good for either a glasses eye examination or contact lens examination.
bulletThis promotion does not include the cost of glasses, contact lenses or other products.
bulletWinners will be notified by telephone and by email..
bulletFamily members and relatives of Dr. Freund are not eligible because they get free eye care anyway.

REGISTRATION FORM
(PLEASE COMPLETE THE FORM ENTIRELY)

First Name Initial Last Name
Address
City   State   Zip Code
Home Phone    Work Phone
Email Address
How Long Since Your Last Eye Examination
Would you like to receive or free monthly newsletter
How did you hear about our website
Are you interested in scheduling an appointment for an eye exam

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