www.kplaservisioncorrection.com Open in urlscan Pro
172.67.174.92  Public Scan

Submitted URL: https://kplaservisioncorrection.org/
Effective URL: https://www.kplaservisioncorrection.com/
Submission: On August 01 via api from US — Scanned from CA

Form analysis 1 forms found in the DOM

POST #anchor_3166

<form enctype="multipart/form-data" action="#anchor_3166" id="anchor_3166_form" class="form-etna-contact" method="post">
  <p class="disclaimer small directionForm">Fields marked * are required</p>
  <input type="hidden" name="orig_page" value="/">
  <input type="hidden" name="vSETCERTID" id="form-cert" value="3166">
  <input type="hidden" id="token_3166" name="token" value="2fedf2c458f160b24a140129573e6655">
  <div class="formContainer" id="contactForm">
    <div class="eii-grid row">
      <div class="eii-col eii-col-medium-12 medium-12 columns">
        <span class="firstname valid"><label for="FirstName" class="screen-reader-text">First Name*</label><input type="text" class="input" id="FirstName" name="firstname" value="" placeholder="First Name:*" aria-required="true"></span>
        <span class="lastname valid"><label for="LastName" class="screen-reader-text">Last Name*</label><input type="text" class="input" id="LastName" name="lastname" value="" placeholder="Last Name:*" aria-required="true"></span>
        <span class="email valid"><label for="Email" class="screen-reader-text">Email*</label><input type="email" class="input" id="Email" name="email" value="" placeholder="Email:*" aria-required="true"></span>
        <span class="phone valid"><label for="Phone" class="screen-reader-text">Phone</label><input type="tel" class="input" id="Phone" name="phone" value="" placeholder="Phone:" aria-required="false"></span>
        <span class="zip valid"><label for="Zip" class="screen-reader-text">Zip*</label><input type="tel" name="zip" class="input" id="Zip" value="" placeholder="Zip Code:*" aria-required="true"></span>
        <label for="Interest" class="screen-reader-text">Procedure Interest</label>
        <select name="interest" class="placeholder interest valid" id="Interest" onchange="this.classList.remove('placeholder');">
          <option selected="" disabled="" value="">Procedure Interest*</option>
          <option value="LASIK"> LASIK</option>
          <option value="Phakic intraocular lens (IOL) surgery"> Phakic intraocular lens (IOL) surgery</option>
          <option value="Photorefractive keratectomy (PRK)"> Photorefractive keratectomy (PRK)</option>
          <option value="Refractive lens exchange (RLE)"> Refractive lens exchange (RLE)</option>
          <option value="Other"> Other</option>
        </select>
        <label for="Location" class="screen-reader-text">Preferred Location*</label>
        <select name="preferred_location" class="placeholder location valid" id="Location" onchange="this.classList.remove('placeholder');">
          <option selected="" disabled="" value="">Preferred Location*</option>
          <option value="Redwood City"> Redwood City</option>
          <option value="San Francisco"> San Francisco</option>
          <option value="Santa Clara"> Santa Clara</option>
          <option value="Santa Rosa"> Santa Rosa</option>
          <option value="Walnut Creek"> Walnut Creek</option>
        </select>
        <textarea name="comments" class="comments" id="Comments" placeholder="Reason for your inquiry"></textarea>
        <div class="checkboxes">
          <span class="valid"><label for="Terms"><input type="checkbox" id="Terms" name="terms" aria-required="true" value="checked"> I accept the <span class="screen-reader-text">Terms of Use</span></label>
            <a id="termsLabel_3166" class="termsSpan">Terms of Use</a><span class="required">*</span></span>
          <div class="termsConditions" id="termsofuse_3166">By checking the box on the contact form, you agree to the Terms of Use listed here: Communications through our website or via email are not encrypted and are not necessarily secure. Use of
            the internet or email is for your convenience only, and by using them, you assume the risk of unauthorized use. By checking this box you hereby agree to hold Kaiser Permanente Laser Vision Correction, its doctors and affiliates, harmless
            from any hacking or any other unauthorized use of your personal information by outside parties.</div>
        </div>
        <div class="submitContainer">
          <div class="validateContainer">
            <div id="slider_full_3166"></div>
          </div>
          <input type="hidden" name="submitted" value="1">
          <input type="text" name="hide1" value="" class="spam" style="display: none;">
          <input type="text" name="hide2" value="" class="fillin spam" style="display: none;">
          <input type="hidden" name="mobileform" id="mobileform" value="0">
          <input type="hidden" name="genhash" value="668c5c11e3253">
          <span class="buttonContainer"><button type="submit" name="Submit" class="submit g-recaptcha" id="submitButton_3166" disabled="disabled">Send</button></span>
          <span class="google-notice">This site is protected by reCAPTCHA and the Google <a href="https://policies.google.com/privacy" target="_blank" rel="nofollow">Privacy Policy</a> and
            <a href="https://policies.google.com/terms" target="_blank" rel="nofollow">Terms of Service</a> apply.</span>
        </div>
      </div>
    </div>
  </div>
</form>

Text Content

 * Home
 * LASIK
   * The LASIK Experience
   * LASIK Technology
   * Am I a Candidate?
   * LASIK FAQs
 * Other Services
   * Phakic Intraocular Lens
   * PRK (Photorefractive Keratectomy)
   * Refractive Lens Exchange
 * Why Kaiser Permanente
 * Resources
   * Understanding Your Vision
   * Video Library
   * Cost & Payment Options
 * Providers
   * Ophthalmologists/Refractive Surgeons
   * Optometrists
   * Other Ophthalmic Staff
 * Locations
 * (888) 330-0665

 * A+
 * A
 * A-


LASER VISION CORRECTION

Break free from the routine of glasses and contacts.
See clearly anytime, anywhere.

Request a Consultation
Request a Consultation LASIK Surgery Other Services


LASIK SURGERY

Measurably safe, incredibly effective, and available without a blade, today's
LASIK procedures look better than ever. Learn more about how you can see clearly
from the moment when you wake up in the morning to when you turn out your light
at night.


Learn More Your Payment Options


OTHER SERVICES

When LASIK isn't a good fit, our other eye surgery services can improve vision
for those who are nearsighted, farsighted, have an astigmatism, or have other
concerns.


PRK RLE Phakic IOL
Your Payment Options


LASIK SURGERY


AM I A CANDIDATE?

If you're curious about your eligibility for LASIK, our brief, informative
questionnaire can help you learn if you're a candidate

Take the Questionnaire


OTHER SERVICES

When LASIK isn't a good fit, our other eye surgery services can improve vision
for those who are nearsighted, farsighted, have an astigmatism, or have other
concerns.

PRK RLE Phakic IOL Your Payment Options



LASIK SURGERY


AM I A CANDIDATE?

If you're curious about your eligibility for LASIK, our brief, informative
questionnaire can help you learn if you're a candidate

Take the Questionnaire


REQUEST A CONSULTATION

Get started today. Use our online form to request a consultation at your
preferred Kaiser Permanente Laser Vision Correction location.

 * FIND A PROVIDER
 * FIND A LOCATION
 * COST & PAYMENT OPTIONS

Fields marked * are required

First Name* Last Name* Email* Phone Zip* Procedure Interest Procedure Interest*
LASIK Phakic intraocular lens (IOL) surgery Photorefractive keratectomy (PRK)
Refractive lens exchange (RLE) Other Preferred Location* Preferred Location*
Redwood City San Francisco Santa Clara Santa Rosa Walnut Creek
I accept the Terms of Use Terms of Use*
By checking the box on the contact form, you agree to the Terms of Use listed
here: Communications through our website or via email are not encrypted and are
not necessarily secure. Use of the internet or email is for your convenience
only, and by using them, you assume the risk of unauthorized use. By checking
this box you hereby agree to hold Kaiser Permanente Laser Vision Correction, its
doctors and affiliates, harmless from any hacking or any other unauthorized use
of your personal information by outside parties.

Send This site is protected by reCAPTCHA and the Google Privacy Policy and Terms
of Service apply.
 * Call Us: (888) 330–0665
 * Find a Provider
 * Find a Location
 * Request a Consultation

 * Privacy Practices
 * Kaiser Permanente Home
 * Related Links
 * Site Map



--------------------------------------------------------------------------------

Learn more about your rights and protections related to the No Surprises Act
(HR133).

Open Payments Database Notice

Kaiser Permanente members typically have coverage for medically necessary eye
examinations, which are generally conducted at Kaiser Permanente facilities.
Otherwise, services described here are provided on a fee-for-service basis.
These services are separate from your Health Plan benefits and are not provided
or covered by Kaiser Permanente Foundation Health Plan, Inc. Clinical services
are provided by providers or contractors of the Permanente Medical Groups.
Results of services vary among patients and cannot be guaranteed. The Permanente
Medical Groups, Kaiser Permanente Foundation Health Plan, Inc., and Kaiser
Permanente Foundation Hospitals have a financial interest in the provision of
these services. For specific information about your Health Plan benefits, please
see your Evidence of Coverage.

Photo(s) of model(s) shown, not actual patient(s).

 * Share
 * +1
 * Tweet
 * 
 * 

Contact
 * Home
 * LASIK
   * LASIK
   * The LASIK Experience
   * LASIK Technology
   * Am I a Candidate?
   * LASIK FAQs
 * Other Services
   * Other Services
   * Phakic Intraocular Lens
   * PRK (Photorefractive Keratectomy)
   * Refractive Lens Exchange
 * Why Kaiser Permanente
 * Resources
   * Resources
   * Understanding Your Vision
   * Video Library
   * Cost & Payment Options
 * Providers
   * Providers
   * Ophthalmologists/Refractive Surgeons
   * Optometrists
   * Other Ophthalmic Staff
 * Locations
 * (888) 330-0665