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Save up to $1,000
on your LASIK procedure
and a FREE pair of Maui Jims^®.

Take the LASIK candidacy evaluation now and set up your FREE consultation to receive this limited time special offer.
*Offer expires on July 31st, 2019.

Am I a candidate for LASIK? Take the FREE LASIK evaluation!

Thank you for Choosing Beach Eye Care, the pioneer in Laser Vision Correction.

Step 1 of 6

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Tell us about your Vision Correction History.
Do you wear contacts or glasses?*
Are your glasses for reading up close?
- Yes
- No
Can you tell us your most recent prescription?
- Yes
- No
Right Eye Prescription
Please include + or -
Left Eye Prescription
Please include + or -

Have you ever had eye surgery?
- Yes
- No
What type of eye surgery did you have?
You came to the right place and thank you giving Beach Eye Care the opportunity to educate you about this life-changing procedure.

Your Thoughts on LASIK
Which is the most important issue for you regarding LASIK?
I am considering LASIK:
(You can use your Health Spending Account benefits!)
What bothers you the most about having to wear glasses and/or contacts?

Would you like to schedule your evaluation appointment today?*
- YES, schedule my LASIK evaluation today!
- No
Can we send you additional information on LASIK?*
- Yes
- No
Email*
Your Evaluation Appointment
Preferred Day of the Week*
Preferred Time
Preferred Time
Questions/Comments:

Your Information
Name*
First Last
What is your age?
How do you prefer to be contacted?
Phone*

Disclaimer
- I am 18 years of age and have had a stable glasses or contact lens prescription for at least two years.
- Have sufficient corneal thickness (the cornea is the transparent part of the eye). A LASIK patient should have a cornea that is thick enough to allow the surgeon to safely create a clean corneal flap of appropriate depth.
- Are affected by one of the common types of vision problems or refractive error - myopia (nearsightedness), astigmatism (blurred vision caused by an irregular shaped cornea), hyperopia (farsightedness), or a combination thereof (e.g. myopia with astigmatism). Several lasers are now approved by the U.S. Food and Drug Administration (FDA) as safe and effective for use in LASIK, but the scope of each laser’s approved indication and treatment range is limited to specified degrees of refractive error.
- Do not suffer from any disease, vision-related or otherwise that may reduce the effectiveness of the surgery or the patient’s ability to heal properly and quickly.
- Are adequately informed about the benefits and risks of the procedure. Candidates should thoroughly discuss the procedure with their physicians and understand that, for most people, the goal of refractive surgery should be the reduction of dependency on glasses and contact lenses, not their complete elimination.
*
- I have read and understand the disclaimer.
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