LASIK Self Test LASIK Self-Test Name:*Phone Number*Email* Do you have trouble seeing far away or up close? Up closeFar away How interested are you in being able to play sports without glasses and contacts?A lotNot reallyWhat is your age?20304050 and over Are you interested in seeing well up close (reading) without glasses? YesNo Do you wear contact lenses or glasses?GlassesContact lensesWould your career or business activities improve if you were to become less dependent on glasses and contacts?YesNoMaybeOver 98% of LASIK patients see 20/40 or better after surgery. The results of LASIK laser vision correction have been tremendous for literally millions of people. Despite the amazing safety and results of this procedure there are associated risks. Are you willing to discuss these risks with our LASIK coordinator?YesNoSubmit