• Multifocal & Toric IOLs
• Dry Eye Test
• Cataract Surgery
• Glaucoma
• Eyelid Surgery

Self-Evaluation Test

Name:
Phone:
E-Mail:

1. Do You Wear Glasses Or Contact Lenses Most of the Time?
   Glasses
   Contacts
2. Are You In Good General Health?
   Yes
   No
3. Do You Have:
   Myopia (Nearvision)
   Hyperopia (Farvision)
   Both
   Astigmatism
4. How Would You Rate Your Quality Of Night Vision?
   Good
   Fair
   Poor
5. Do You Currently Require Reading Glasses?
   Yes
   No
6. Which is The Most Important Issue For You Regarding LASIK?
   Outcome
   Affordability
   Being free of my Glasses or Contacts
7. Do you have apprehensions or confusions about LASIK?
   Yes
   Possibly
   No
8. Are you concerned that the risks may outweigh the benefits of LASIK?
   Yes
   Possibly
   No
9. Are you?
   20 – 30 years old
   30 – 45 years old
   Older than 45?