LASIK CANDIDACY TEST
Nielsen Eye Center
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What is your age group?
Without my glasses and contacts (check all that apply)
I have trouble reading and seeing things up close
I have trouble driving and seeing things far away
I have been told that I have astigmatism
What do you usually wear?
Do you have any of the following
Prior Eye Surgery
I am currently pregant
Prior services eye injury
None of the above
How interested are you in being able to enjoy outdoor activities and / or sports without glasses and contacts?
It's very important to me NOT to wear glasses for outdoor activities and / or sports
It's not important to me, I do not mind wearing glasses
Are you interested in seeing well up close(reading) without glasses?
It's very important to me NOT to wear reading glasses
It's not important to me. I do not mind wearing reading glasses to see things up close
Would your career or business activities improve if you were to become less dependent on glasses and contacts?
Would you be willing to discuss this procedure and your candidacy with our coordinator?
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