LASIK Self Test LASIK Self Test Name*Email* Phone*1. Do you have trouble seeing far away or up close?SelectUp CloseFar Away2. How interested are you in being able to play sports without glasses and contacts?SelectIt's very important to me NOT to wear glasses for activities such as sports.It's not important to me. I do not mind wearing glasses.3. What is your age?SelectUnder 2121-4040-6969+4. Are you interested in seeing well up close (reading) without glasses?SelectIt's very important to me NOT to wear reading glassesIt's not important to me. I do not mind wearing reading glasses to see things up close.5. Do you currently wear glasses or contact lenses?YesNo6. Would your career or business activities improve if you were to become less dependent on glasses and contacts?SelectYesNoMaybe7. Health insurance plans normally do not cover the cost of Lasik, for that reason, we offer financing options for patients. Would you be interested in learning about these financing options?SelectYesNo
