LASIK Evaluation

Interested in having LASIK?

Not sure if you’re a good candidate? Start here by filling out our patient survey to help you decide if LASIK might be a good option for you.

Self Evaluation             *indicates required field
First Name* Last Name*
Email* Phone*
What is your age group:



Do you wear:
Glasses
Contact Lenses
Both
Are you:
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?
Yes
No
Have you been told you have...
Cataracts
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

 


Copyright © 2016 Valley Eye Associates. All rights reserved. | Privacy Policy
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Copyright © 2016 Valley Eye Associates. All rights reserved. | Privacy Policy
Refractive Marketing and Web Design by Eyemax