LASIK Candidacy Test - Hamilton Eye

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LASIK Candidacy TestAdmin2019-05-31T17:10:56+00:00

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
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