What’s Your Age? *

18-24

25-40

41-59

60+

Which type of corrective eyewear do you use? *

Glasses

Contact Lenses

Readers / Bifocals

None of These

Which best describes your vision today? *

Nearsighted - Difficulty Seeing At A Distance

Farsighted - Difficulty Seeing Up Close

Presbyopia - Difficulty Seeing In Dim Light

Astigmatism - Overall Blurry Vision

Have you ever been diagnosed with cataracts? *

Yes

No

What is your biggest concern with LASIK? *

Affordability

Experience of Surgeon

Safety

Recovery Time

If you woke up tomorrow with crisp clear vision, what’s the very first activity you would enjoy?

Just one more step!

First Name *

Last Name *

Phone *

Email *

How soon would you be interested in vision correction? *

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