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Baylor Eye Center LASIK Assessment
Find out if you are a candidate. Please complete the assessment.
7
Questions
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HIPAA
Compliance
1
Unique ID
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2
What is your current age?
If 55+ please call 713-798-6100 to schedule a consultation.
18-49
50-55
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3
Do you wear contact lenses or glasses to see your best?
YES
NO
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4
Are you interested in being free of glasses and/or contact lenses?
Yes
No
Not Sure
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5
Have you ever been told you have any of the following?
Select all that apply.
Keratoconus
Cataracts
Glaucoma
Severe dry eye
Retinal disease
Diabetes
Autoimmune disease
None of the above
Astigmatism
Other
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6
Have you had previous eye surgery?
Select all that apply.
No
LASIK/PRK
Cataract surgery
Other
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7
Are you currently pregnant or nursing?
Select all that apply.
Yes
No
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8
What is your primary concern with LASIK?
Safety of procedure
Recovery time
Affordability
Other
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9
Please provide your contact information and we will call you back!
We appreciate your interest in Baylor Medicine Eye Care. A member of our team will reach out to you within 48 hours, or you can reach us directly at (713) 798-8273. For cataract evaluation, please contact us at (713) 798-6100. Feel free to visit our website by clicking
here
.
First and last name as it appears on your government issued ID
Email
Preferred phone number
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10
Please verify that you are human
*
This field is required.
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Baylor Eye Center LASIK Assessment
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