1What Is Your Age Group? 18-35 36-55 56+ Next Step2Do you currently wear… Glasses Contacts Both Neither Previous StepNext Step3Without corrective lenses, do you have… Trouble seeing far away Difficulty seeing up close Overall blurry vision Trouble with reading only Previous StepNext Step4Have you ever been told you have astigmatism? Yes No Previous StepNext Step5Have you ever been told you have dry eyes? Yes No Not sure Previous StepNext Step6PLEASE PROVIDE YOUR PHONE NUMBER AND EMAIL ADDRESS TO FIND OUT IF LASIK IS RIGHT FOR YOU Name* Phone* Email* Previous Step Submit Form
