LASIK Questionnaire

Are You a Candidate for Laser Vision Correction?
Take this short survey to find out!

Are you twenty one years or older?*

Yes
No

Do you wear glasses and/or contact lenses?*

Yes
No

Are you nearsighted, farsighted, and/or have astigmatism?*

Yes
No

Do you want to reduce your dependency on glasses and/or contacts?*

Yes
No

Do you feel your appearance would improve if you did not have to wear glasses?*

Yes
No

Would you be interested in confirming you are a candidate for laser vision correction if you could have a free, no obligation consultation?*

Yes
No

If you answered "yes" to any one or more of these questions, you are probably a candidate for laser vision correction. Take advantage of this special offer for patients of the doctors at Vision Health Specialties and schedule a free, no obligation consultation.

It's easy, and it's free.

Name*

First Last

Phone*

Email*

LASIK Questionnaire

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Vision Health Specialties

LASIK & Refractive Surgery Co-Management

Scleral Lenses Can Let Anyone wear Contact Lenses!

Vision Therapy for Children