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LASIK
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Self-Evaluation TEST
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FAQ
LASIK Winners
Name:
Primary Phone:
2nd Phone:
E-Mail:
How did you hear about us?
(Please select)
Facebook
Google Search
Yahoo Search
MSN Search
Newspaper
Magazine
Word of Mouth
Other
Do you have trouble seeing far away or up close?
Up close
Far away
Both
What is your current method of vision correction method?
Glasses
Soft contact lenses
Toric soft contact lenses
Gas permeable lenses
What is your age?
Under 21
21 - 40
40 - 69
69+
Are you interested in seeing well up close (reading) without glasses?
It's very important to me NOT to wear reading glasses.
It's not important to me. I do not mind wearing reading glasses to see things up close.
Would your career or business activities improve if you were to become less dependent on glasses and contacts?
Yes
No
Maybe
Do you know your visual prescription?
Select
+6.00
+5.75
--------
+5.50
+5.25
+5.00
+4.75
+4.50
+4.25
--------
+4.00
+3.75
+3.50
+3.25
+3.00
+2.75
--------
+2.50
+2.25
+2.00
+1.75
+1.50
+1.25
--------
+1.00
+0.75
+0.50
--------
-0.50
-0.75
--------
-1.00
-1.25
-1.50
-1.75
-2.00
-2.25
--------
-2.50
-2.75
-3.00
-3.25
-3.50
-3.75
--------
-4.00
-4.25
-4.50
-4.75
-5.00
-5.25
--------
-5.50
-5.75
-6.00
-6.50
-7.00
-7.50
--------
-8.00
-8.50
-9.00
-9.50
-10.00
-10.50
--------
-11.00
-11.50
-12.00
Do your eyes hurt after prolonged eyewear use?
Yes
No
Do you have astigmatism?
Yes
No
Has your prescription been stable over the last two years?
Yes
No
Over 98% of LASIK patients see 20/40 or better after surgery. The results of LASIK laser vision correction have been tremendous for literally millions of people. Despite the amazing safety and results of this procedure there are associated risks. Are you willing to discuss these risks with our LASIK coordinator?
Yes
No
If you have been told that you are not a candidate for LASIK, would you like to hear about other possible options?
Yes
No
LASIK Self - Evaluation Test
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What to Expect
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