LASIK Self Evaluation

Do you have trouble seeing far away or close up?

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
60+

Are you interested in seeing well up close (reading) without glasses?

It's very important to me NOT to wear reading glasses. First Choice
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?

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

What is two plus two?

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