LASIK Self Evaluation Test

To better understand your candidacy for laser vision correction, please take a moment to answer the following 10 questions. Once your personal visual needs are determined, one of our counselors will contact you to answer your questions related to LASIK.


  1. (required)
  2. (required)
  3. (valid email required)
  4. How did you hear about us?
  5. What is your age?
  6. Do you know your prescription?
  7. Has your prescription been stable for the last two years?
  8. Do you have trouble seeing distance or near without your glasses?
  9. Do you wear reading glasses or bifocal glasses?
  10. What is your current method of vision correction?
  11. Do you have any dry eye symptoms?
  12. Are you familiar with different LASIK technologies such as the difference between traditional microkeratome LASIK and all-laser LASIK?
  13. Have you ever been through a LASIK evaluation?

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