Laser Suitability

First Name *

Last Name *

Email *

Contact Phone

Location *

Age *

When are you considering having laser eye surgery? *

Have you had laser refractive surgery or any other eye surgery previously? *

Do you wear glasses, contact lenses, or both? *

Which distance do you wear your correction for? *

How old were you when you first started wearing glasses? *

Are you shortsighted or farsighted? *

Do you have astigmatism? *

Is there a family history of keratoconus or conical cornea? *

Have your prescription changed in the last two years? *

Do you experience dry eye symptoms or need to use eye drops regularly? *

Are you currently pregnant or breastfeeding? *

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