LASIK Quiz

Wondering If LASIK is Right For You?

Take this 5 minute quiz to see if you're eligible for the procedure!
About You
Name*

First NameLast Name
Birth Date*

MonthDayYear
Phone Number*
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Email*
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Zip Code*
How did you find us?*

Search Engine (Google, Bing, etc.)Social Media (Instagram, Facebook, etc.)Personal ReferralDoctor ReferralJumbotron/SignageOther (please specify)
Please verify that you are human*

Question 1/3
Which of the following vision aids do you use? (Select all that apply.)*

Contact lensesPrescription glassesReading glassesNone

Question 2/3
What does your vision look like without your vision aids? (Select all that apply.)*

I have trouble seeing up closeI have trouble driving and seeing far awayMy vision is distorted and I can't see anything wellNone of these

Question 3/3
Which of the following apply to you? (Select all that apply.)*

I am currently pregnant or nursing.I have had a previous eye injury, infection or surgery.I have cataracts.I have keratoconus.None of these apply to me.
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