Are you a candidate?

There is a FDA approved treatment range to maintain the safety of each patient. Please take the short questionnaire to find out if you may be a good candidate for a Laser Vision Correction procedure.
 

Name:*
Phone:*
-
E-mail:*
E-mail confirmation:*
What is your preferred method of communication?
How old are you?*
Do you wear glasses or contacts?*
Which distances do you have trouble seeing without glasses or contacts?*
Do you have any of the following eye conditions? (please check all that apply).*
Do you have any of the following conditions? (please select all that apply).*
Are you currently pregnant, breastfeeding or planning to become pregnant within the next 6 months?*
Has your prescription for your glasses or contacts changed in the past two years?*
Are you currently taking any medications, such as steroids or immunosuppressants, which can slow or prevent healing?
Which of the following statements BEST reflects your primary reason for seeking a laser vision correction (LVC) procedure?
Who or which of the following influenced you to contact this center?
Word Verification: