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LASIK Self Evaluation
Laser Eye Center
> LASIK Self Evaluation
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LASIK Self Evaluation
Find out if you could be a candidate for LASIK today!
First Name
(required)
Last Name
(required)
Email
(valid email required)
Phone
Do you wear glasses or contact lenses?
Glasses
Contact Lenses
Do you have trouble seeing up close or far away?
Up close
Far Away
Is it important for you to be active without having to wear glasses or contacts? (Ex. swimming or sports)
Yes
No
How old are you?
Under 21
21 - 40
41 - 69
Over 69
Would you like to be able to read without glasses?
Yes
No
Would your job performance improve if you no longer had to wear glasses or contacts?
Yes
No
Maybe
LASIK is now the number one procedure for correcting nearsightedness, farsightedness and astigmatism. Are you interested in learning more about the procedure from our LASIK coordinator?
Yes
No
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