About LASIK

How would you like to be contacted?

•  I'd like the doctor to call me
•  I'd like the doctor email me
•  I'd like to come in to see the doctor — call me with an appointment

Which of the following statements best reflects your primary reason for seeking LASIK surgery?

•  I would like to get LASIK for career reasons.
•  I would like to get LASIK for lifestyle reasons (for example, sports, leisure activities, etc.)
•  I think I look better without glasses and do not like contact lenses.
•  I would like to reduce my dependence on glasses and/or contact lenses.
•  I would like to completely eliminate my need for glasses and/or contact lenses.

Do you have any of the following conditions? (Please select all that apply.)

•  Diabetes
•  Autoimmune disease (for example, AIDS, lupus, rheumatoid arthritis, multiple sclerosis, or myasthenia gravis)
•  Immunocompromised for any reason
•  Collagen vascular disease
•  Pregnancy or nursing
•  To the best of my knowledge, I have none of these conditions

Do you have any of the following conditions? (Please select all that apply.)

•  Keratoconus or other corneal thinning disorder
•  Corneal scarring
•  Glaucoma
•  Cataracts
•  Ocular herpes diagnosed in past year
•  Retinal disease
•  Dry eye
•  To the best of my knowledge, I have none of these conditions

What type of refractive error do you have?

•  Nearsightedness
•  Farsightedness
•  Astigmatism
•  Don't know

Has your vision correction — that is, your glasses or contact lens prescription — changed over the past year or two?

•  Yes
•  No