LASIK Self-Test:
(1/7) How Old Are You?
*
Under 18
18-39
40-59
60+
(2/7) Do You Wear...
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Glasses
Contacts
Glasses & Contacts
Neither
(3/7) Without Your Corrective Lenses, Do You Have...
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Trouble seeing far away
Trouble seeing up close
Overall blurry vision
Trouble with reading only
(4/7) Have You Ever Been Told You Have Astigmatism?
*
Yes
No
(5/7) What's Your Name?
First Name
*
Last Name
*
(6/7) What Email Can We Contact You At?
*
(7/7) What Phone Number Can We Text Your Results To?
*