LASIK Test Boston Quincy MA

Self Evaluation

Please complete the form below. Once you submit the form one of our Patient Advocates will contact you and answer any questions you may have and schedule you for a Free V.I.P. LASIK Consultation. We look forward to hearing from you!

Name(required)
Email(valid email required)
Phone Number(required)
Do you have trouble seeing far away or up close?||
Far Away Up Close
How interested are you in being able to play sports without glasses and contacts?
It's very important to me NOT to wear glasses for activities such as sports It's not important to me. I do not mind wearing glasses
What is your age?
Under 21 21-40 41-70 Over 70
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 close
Do you wear contact lenses or glasses?
Contact lenses Glasses
Would your career or business activities improve if you were to become less dependent on glasses and contacts?
Yes No Maybe
Over 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?
Yes No
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