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

Gender

Female

Male

How old are you?

18-24

25-40

41-60

Over 60 years of age

You have trouble seeing: *

Up close

Far away

Both

I do not know

Do you have astigmatism? *

Yes

No

I do not know

You wear: *

Eyeglasses

Contact lenses

Both

I don't wear eyeglasses or contact lenses

Has your diopter changed in the past year? *

Yes

No

I do not know

If you are a good candidate, when you would like to have surgery? *

As soon as possible

In 1-3 months

In 3-6 months

In 6-12 months

I do not know, I am still thinking about the surgery

Do you have any of these eye diseases? *

Allergic eye inflammation

Dry eye

Keratoconus (or other degenerative corneal thinning disease)

Scar on the cornea

Cataract

Glaucoma

Ophthalmic herpes (diagnosed in the past year)

Diabetic retinopathy

None of the above

I do not know

Do you have any of these systemic illnesses?

Rheumatoid arthritis or some chronic rheumatic disease

Autoimmune Disease (Collagenases)

Diabetes: (unregulated form)

Thyroid disease (unregulated form)

I do not know

I do not

Are you pregnant? *

Yes

No

Do you breastfeed? *

Yes

No

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

Lifestyle - I want to be able to do everything I want without worrying about glasses or contact lenses

Aesthetics - I want people to see my eyes without glasses

Freedom - I want to reduce the dependence on glasses and contact lenses

Uncomfortable - Contact lenses started to bother me

Cost - Glasses and contact lenses are overpriced

Career - I cannot wear glasses or contact lenses for the work I am doing

How did you find out about us?

Internet

Facebook

Instagram

Newspaper

Radio

Friends

Family

Name and surname: Molimo unesite ime i prezime!

Date of birth: Molimo unesite datum i godinu rođenja!

Phone: Molimo unesite broj telefona!

City: Molimo unesite grad!

E-mail: Molimo unesite e-mail adresu!