Is Laser Vision Correction Right for You?

Answer these few questions to find out if you are a candidate
for Lasik or any other vision correction procedure:

*Name
*Address
*City
*State
*Zip
*E-Mail
Phone
Are you at least 18 years old? Yes No
Has your vision been stable for at least 1 year? Yes No
Are your eyes free from cataracts, glaucoma, infections? Yes No
Are you pregnant or nursing an infant? Yes No
Did you wear glasses before age 40 to 50? Yes No
Do you need glasses only for reading small print? Yes No
Do your glasses or contact lenses bother you? Yes No
If you lost your glasses or contacts and didn't have another pair with you, would you be upset? Yes No
Are you unable to wear contacts? Yes No
Would you like to see your alarm clock and other things clearly when you awake? Yes No
Would you like us to send you an information packet? Yes No

If you know your prescription, please complete the next section.  
My prescription is OD (right eye)
Sphere Cylinder Axis

My prescription is OS (left eye)
Sphere Cylinder Axis
 

*denotes required field

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