What is your age now ?
*
Less than 18 yrs
18 to 40 yrs
More than 40 yrs
What do you wear now ?
*
Glasses
Contact Lenses
Glasses + Contacts
Weak Eyesight
Do you have any of the following?
*
Trouble seeing far away
Trouble seeing up close
Overall blurry vision
Do you have any of the following?
*
Diabetes
Autoimmune diseases
Previously had major eye trauma
Cataract
None of the above
Are you pregnant or nursing a baby?
*
Yes
No
Not applicable
What is the purpose of doing lasik ?
*
glasses bother me while doing sports activity
professional reason
before marriage
for lifestyle
too dependent on glasses
I want to keep the reason confidential
Full Name
*
Phone Number
*
Email Address
*
SUBMIT
8657705131
8657705131
Free Pre-LASIK Test
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What is your age now ?
*
Less than 18 yrs
18 to 40 yrs
More than 40 yrs
What do you wear now ?
*
Glasses
Contact Lenses
Glasses + Contacts
Weak Eyesight
Do you have any of the following?
*
Trouble seeing far away
Trouble seeing up close
Overall blurry vision
Do you have any of the following?
*
Diabetes
Autoimmune diseases
Previously had major eye trauma
Cataract
None of the above
Are you pregnant or nursing a baby?
*
Yes
No
Not applicable
What is the purpose of doing lasik ?
*
glasses bother me while doing sports activity
professional reason
before marriage
for lifestyle
too dependent on glasses
I want to keep the reason confidential
Full Name
*
Phone Number
*
Email Address
*
SUBMIT
LASIK Self Test
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