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Your Name (required)
Your Email (required)
Your Phone (required)
What is your age?
Do you wear contact lenses or glasses?
Do you have trouble seeing far away or up close?
Up CloseFar AwayBoth
Are you interested in seeing well up close (reading) without glasses?
It's very important for me to NOT wear reading glasses.It's not important to me. I do not mind wearing reading glasses to see things up close.
Would you enjoy being able to play sports without glasses/contacts?
It's very important for me to NOT wear glasses for activities such as sports.It's not important to me. I do not mind wearing glasses.
Would your career improve if you were to become less dependent on glasses and contacts?
Over 99% of LASIK patients are able to drive without glasses after surgery. The results of LASIK and laser vision correction have been tremendous for literally millions of people. Despite the amazing safety and results of this procedure, there are risks associated with any surgical procedure. Are you willing to discuss these risks with our LASIK coordinator?
Please do not submit any sensitive information through this form.
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