LASIK Candidacy Test - Hamilton Eye

Skip to main content

Hit enter to search or ESC to close

Contact Us | 424-732-2020

Dr. Hamilton
My Age Range
Eye Conditions
Procedures
Patient Center
Schedule Consultation
- Contact
  - Our Location

LASIK Candidate Survey

Step 1 of 9

11%

First Name*
Last Name*
Email*
Phone*

What is your age?*
- Under 18
- 19-39
- 40-59
- 60+

Without my glasses and contacts...*
- 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?*
- Glasses
- Contacts
- Reading Glasses

Do you have any of the following?*
- Cataracts
- Keratoconus
- Diabetic Retinopathy
- Prior Eye Surgery
- Prior serious eye injury
- I am currently pregnant
- None of the above

How interested are you in being able to enjoy outdoor activities and/or sports without glasses and contacts?*
- It's very important to me NOT to wear glasses for outdoor activities and/or sports
- It's not important to me. I do not mind wearing glasses

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

Would your career or business activities improve if you were to become less dependent on glasses and contacts?*
- Yes
- No
- Maybe

Would you be willing to discuss this procedure and your candidacy with our coordinator?*
- Yes
- No
CAPTCHA
Email
This field is for validation purposes and should be left unchanged.

Dr. Rex Hamilton, MD is a board certified, world-renowned eye surgeon who specializes in premium cataract and refractive eye surgery in Beverly Hills

Contact Us | 424-732-2020

Dr. Hamilton
My Age Range
Eye Conditions
Procedures
Patient Center
Schedule Consultation
- Contact
  - Our Location