Save up to $1,000 on your LASIK procedure. Take the LASIK evaluation now and set up your FREE consultation to receive this limited time special offer. *Offer expires on June 30th, 2019. Am I a candidate for LASIK? Take the FREE LASIK evaluation! Take the LASIK evaluation below to find out if you are a candidate for LASIK.Your InformationName* First Last Phone*Email* What is your age?Your Contact PreferencesHow do you prefer to be contacted?– Select –Text MessagePhoneEmailNo PreferenceYour Glasses/Contacts InformationDo you wear glasses?YesNoDo you wear contacts?YesNoAre your glasses for reading up close?YesNoCan you tell us your most recent glasses or contact lens prescription?YesNoRight Eye PrescriptionPlease include + or -Left Eye PrescriptionPlease include + or -Have you ever had eye surgery?YesNoYour Thoughts on LASIKWhich is the most important issue for you regarding LASIK?– Select –AffordabilitySafetyExperience of doctorBeing free of my glasses or contactsI am considering LASIK:– Select –NowIn the near futureNext year(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! Your Evaluation AppointmentPreferred Day of the Week*– Select –MondayTuesdayWednesdayThursdayPreferred Time8:15 am9:15 am10:15 am11:15 am12:30 pm1:30 pm2:00 pm3:30 pmPreferred Time12:30 pm1:30 pm2:00 pm3:30 pmQuestions/Comments:* I have read and understand the disclaimer. 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. Please confirm you are not a robot.
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