Am I a Candidate for LASIK?

First Name (required)

Last Name (required)

Your Email (required)

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In the past 3 months, have you been pregnant/nursing/breastfeeding?*
YesNo
What type of refractive error do you have?*
Nearsightedness (myopia) -- you have trouble seeing distanceFarsightedness (hyperopia) -- you have trouble seeing up closeReading (presbyopia) -- you have trouble seeing intermediateI don't know
Do you have astigmatism?*
YesNoI don't know

When was your last noticed vision change (date)?*

Do you have any of the following conditions? Keratoconus or other corneal thinning disorderCorneal scarringGlaucomaCataractsOcular herpes diagnosed in past yearDiabetesAutoimmune disease (for example, AIDS, lupus, rheumatoid arthritis, multiple sclerosis, or myasthenia gravis)Immunocompromised for any reasonCollagen vascular disease
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