TESTFind out if you are a good candidate for laser vision correction

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Answering these questions will help us determine if you are a good candidate for laser correction.

If you decide to have laser vision correction after completing the test, you’ll only pay for the procedure, as the consultation fee will be deducted from the price of the surgery.

Gender*

Gender*

How old are you?*

How old are you?*

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What kind of vision problem do you have?*

What kind of vision problem do you have?*

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Do you currently wear:*

Do you currently wear:*

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Has your diopter changed in the past year?*

Has your diopter changed in the past year?*

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Do you have any of these eye diseases?*

Do you have any of these eye diseases?*

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Do you have any of these systemic illnesses?*

Do you have any of these systemic illnesses?*

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Are you pregnant?*

Are you pregnant?*

Do you breastfeed?*

Do you breastfeed?*

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What is the main reason why you want the laser vision correction?*

What is the main reason why you want the laser vision correction?*

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How did you hear about us?*

How did you hear about us?*

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Name and surname:*

Name and surname:*

Please enter your first and last name!

Date of birth:*

Date of birth:*

Please enter your date and year of birth!

Phone:*

Phone:*

Please enter your phone number!

E-mail:*

E-mail:*

Please enter your e-mail address!

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