First Step: Take Our Free LASIK Self-Evaluation This is a quick questionnaire to find out if you might be a good candidate for LASIK. Please Select Your Age Under 18 19 – 39 40 – 59 60+ What do you usually wear? (Check All that Apply) Glasses Contacts Reading Glasses Without my glasses and contacts: (check all that apply) I have trouble reading and seeing things up close I have trouble driving and seeing things that are far away I’ve been told that I have astigmatism Do you have any of the following? Rheumatoid Arthritis Multiple Sclerosis Lupus Cataracts Keratoconus Diabetic Retinopathy Prior Eye Surgery Prior serious eye injury I am currently pregnant None of the above Yes, I would like to schedule a FREE Consultation. The best time to call me is: 8am-12pm 12pm-4pm 4pm-7pm Please provide us with your contact information First Name Last Name Email Phone Am I a LASIK Candidate?