LASIK Self-Evaluation

Are you a good candidate?

If you wear glasses or contact lenses and have wondered if you might be a candidate for vision correction surgical procedures such as LASIK or PRK, taking a self evaluation is your next step! Fill out the form below to see if you might be a candidate for this potentially life-changing surgery.

* indicates a required field
Select your gender
Are you currently breastfeeding, pregnant, or planning to become pregnant within the next 6 months?
Which of the following statements best reflects your primary reason for seeking LASIK surgery?
Like all surgical procedures, LASIK has the risk of complications, and even complication-free procedures can result in less than 20/20 vision. Are you willing to educate yourself about those risks, accept a reasonable risk if you are an appropriate candidate, and comply with a schedule of post-surgery medications and follow-up exams?
Do you have any of the following conditions? (Please select all that apply)
Are you currently taking medications, such as steroids or immunosuppressants, which can slow or prevent healing?
Do you have any of the following conditions? (Please select all that apply)
Which type of refractive error do you have?
Do you have astigmatism?
What level of nearsightedness (myopia) do you have?
What degree of astigmatism do you have?
Has your vision correction – that is your glasses or contact lens prescription – changed over the past year or two?
Have you ever been a patient at Marietta Eye Clinic?
Consultation
Do you give Marietta Eye Clinic consent to reach out via Text Message?

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