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CALL OR TEXT: (919) 510-6830 info@traverslasik.com
  • (Please print your name above – First, Middle, Last)
  • Dr. Travers may require a copy of your previous records to provide you the best possible care.
  • (Please print above – Your Eye Doctor’s Name and/or Practice Name)


  • To release ALL MEDICAL RECORDS pertaining my health / eye examinations including but not limited to:

    • Minimum 2-3 full exams (if available) more may be requested if needed
    • Refraction with visual acuity
    • Keratometry
    • Autorefractor tape of data
    • Ocular / systemic health
  • Please submit to:
    Travers Lasik Vision Center
    2501 Atrium Drive, Suite 200
    Raleigh, NC 27607
    Phone# (919)510-6830
    Fax# (919)510-6835



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