1- To start, please tell us how old you are: *

Under 45

45-60

60+

2- Do you have to wear glasses/contacts for...? *

Driving

Computer

Reading

All of the above

3- Have you ever been told you have astigmatism? *

Yes

4- Have you ever been told you have a cataract?

Yes

5- Is your current prescription...

Higher than -8 (ex. -9, -10, -11...)

Lower than -8 (ex. -6, -5, -4...)

I'm farsighted (ex. +1, +2, +3...)

I'm not sure

6- Have you had any of the following procedures on your eyes (LASIK, PRK, RK, Cataract Surgery)? *

Yes

*This does not disqualify you from Modern Vision Correction

7 - What is your first name? *

What is your last name? *

What email should we send the results to? *

8- Phone *

I agree to receive calls, SMS and email messages from K2 Vision and King LASIK, including appointment reminders, scheduling updates, post-procedure instructions, billing notifications, and promotional or marketing messages such as special offers, new services, and practice updates. Message frequency varies. Message and data rates may apply. Reply STOP to opt out at any time. Reply HELP for assistance. Consent is not a condition of purchase. View our terms and conditions and privacy policy.