|Self Evaluation *indicates required field
|What is your age group:
|Do you wear:
Nearsighted (trouble seeing far away)
Farsighted (trouble seeing close up)
Astigmatism (double images)
Wear over the counter reading glasses
|Have you had prior eye surgery?
|Have you been told you have...
Any other eye disease
Any previous corneal scarring due to past eye injuries
None of the above
|How important is it to see up close without reading glasses after having laser vision correction?
I do NOT want to wear reading glasses
I don’t mind wearing reading glasses
I am uncertain
|What do you hope for most if you have LASIK?
Being able to enjoy activities with more freedom from glasses and contacts
Positive impact on my career with more freedom from corrective lenses
See better overall