LASIK Candidacy Self-Evaluation Please complete the following form to see if you are a candidate for LASIK surgery. Name* First Last Phone Number*Email* What is your age group?What is your age group?18-3536-4955+Do you wear...Do you wear...GlassesContactsBothNoneHave you ever been told you have astigmatism?Have you ever been told you have astigmatism?YesNoAre you currently being treated for dry eye disease?Are you currently being treated for dry eye disease?YesNoCAPTCHA
