Please fill out the form below:
"Refer a new patient and get 50% off
your next recare appointment.*"
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*Certificate
with offer will be e-mailed to Sender at the time of new patient
appointment. This promotional offer cannot be combined with
any other offers, discounts or promotions. This offer is intended
for individual use only. Each Sender may only get one Certificate
per new patient referred. Senders may not send Certificates
to themselves. By sending this form, each Sender consents to
the release of
his or her first and last name to the Recipient(s). |
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