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LASIK Candidacy Quiz
find out if Lasik Surgery is right for you
Which describes your vision:
select one
Select One
I have trouble seeing at a distance.
I only need glasses for reading and detailed up close work.
I need glasses for distance and reading.
I have an astigmatism.
What type of vision correction do you currently wear?
select all that apply
Contacts
Glasses
Multi-lens (Bi-focals, tri-focals)
Reading glasses only
I do not wear vision correction at this time.
Health History
select all that apply
Keratoconus
Pregnant or nursing
Have you had an eye injury causing significant corneal scarring (the clear, dome-shaped part of the eye)
Do you have an active eye infection or inflammation
Have you been or are you being treated for:
select all that apply
Autoimmune disease
Collagen vascular disease
Herpes Keratitis
Amblyopia or "lazy eye"
Age
select one
Select One
Under 18
18-59
60+
Name
full name
Email
a valid email
Phone #
(xxx) xxx-xxxx
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