Refractive Surgery Candidacy Questionnaire

Tired of glasses or contacts? Take this short quiz to find out if you’re a candidate for LASIK or other vision correction procedures.

1. What's your current method of vision correction?
2. How long have you been wearing glasses or contacts?
3. Do you know your approximate prescription?
4. Have you ever been told you're not a candidate for LASIK or PRK?
5. What's your main goal with vision correction?
6. Are your eyes generally healthy (no infections, dryness, or recent surgeries)?
7. Have you ever been diagnosed with any of the following? (Check all that apply)
What's your age range?
9. When are you hoping to have vision correction done?
10. Would you like to learn about options beyond LASIK, like PRK or EVO ICL, if you're not a LASIK candidate?
Tell us how we can contact you with your personalized results and next steps:
Preferred contact method:

Optional: Is there anything you'd like us to know about your vision or concerns?

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