LASIK Evaluation Find out if you're a candidate for LASIK by completing the form below. Evaluation Questions Please Select Your Age Under 18 19 - 39 40 - 59 60+ What do you usually wear? Glasses Contacts Reading Glasses Select all that apply Without my glasses and contacts: I have trouble reading and seeing things up close I have trouble driving and seeing things that are far away I've been told that I have astigmatism Select all that apply Do you have any of the following? Rheumatoid Arthritis Multiple Sclerosis Lupus Cataracts Keratoconus Diabetic Retinopathy Prior Eye Surgery Prior serious eye injury I am currently pregnant None of the above Select all that apply Yes, I would like to schedule a FREE Consultation. The best time to call me is: 8am-12pm 12pm-4pm 4pm-7pm Please Provide Your Contact Information First Name Last Name Email Phone Am I a LASIK Candidate?