LASIK CANDIDACY TEST
1
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What is your age group?
Under 18
19-39
40-59
60+
Without my glasses and contacts
check all that apply
I have trouble reading and seeing things up close
I have trouble driving and seeing things far away
I have been told that I have astigmatism
What do you usually wear?
check all that apply
Glasses
Contacts
Reading Glasses
Do you know your prescription ?
+4 or higher
+3 to 0 (plano)
-1 to -5
-6 to -8
-9 or higher
I don't know
Has your prescription been stable for the last two years?
Yes
No
I don't know
Are you interested in seeing well up close (reading) without glasses?
It's very important to me NOT to wear reading glasses.
It's not important to me. I do not mind wearing reading glasses to see things up close.
Have you ever been through a LASIK evaluation?
Yes. I have been told that I am a candidate for LASIK or another type of vision correction surgery
Yes. But I have been told that I am not a candidate for eye surgery
No. I have not had a LASIK evaluation
When are you looking to have the procedure done?
Now or within the next 6 months
Within a year
Over a year from now
CANDIDACY TEST
LIKELY
You are likely a candidate