Furlong Vision Correction
Patient Services Department
Suite 210
2640 East Main Street
Springfield, IL 62701
United States
Phone: (217) 555-7428
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Helping You See Life Clearly
Thank You For Choosing Furlong Vision Correction
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Provider
Dr. Sarah Furlong
Procedure
LASIK Consultation
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Date: 6/10/2026
Time: 6:16:09 PM
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1
Initial Vision Assessment
$150.00
1
LASIK Consultation
$200.00
1
Follow-Up Evaluation
$75.00
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Subtotal$550.00
Medical Service Tax$0.00
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Payment MethodCredit Card (VISA)
Card Last 41234
Entry MethodCard Present
Authorization Code583921
StatusApproved
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Please retain this receipt for insurance records.
For questions regarding your visit, contact our office.
Thank you for choosing Furlong Vision Correction!
