LASIK Evaluation

The only accurate way to know if LASIK is right for you is to have have a thorough LASIK Consultation, but this Self-Evaluation will tell you if you’re in the ball park. Answer each question and fill out your name, email address and contact number and a LASIK Specialist will contact you with the results.

Name:
Phone:
E-Mail:

1. Do you wear glasses or contact lens most of the time?
   Glasses
   Contacts
2. Are you in good general health?
   Yes
   No
3. Have you ever had an eye injury or eye surgery?
   Yes
   No
4. Do you have any of the following?
   Myopia (Nearvision)
   Hyperopia (Farvision)
   Astigmatism
5. How would you rate your quality of night vision?
   Good
   Fair
   Poor
6. Do you currently require reading glasses?
   Yes
   No
7. Which is the most important issue for you regarding LASIK?
   Outcome
   Affordability
   Being free of my Glasses or Contacts
8. Do you have apprehensions or confusions about LASIK?
   Yes
   Possibly
   No
9. Are you concerned that the risks may outweigh the benefits of LASIK?
   Yes
   Possibly
   No
10. Are you aware of the technical benefits of LASIK?
    Yes
    Possibly
    No

Submit