Am I a Candidate for LASIK?"

Take this two-minute screening test and generate your own custom report.

LASIK can be very successful when performed on the right patients, but it is not for everyone. This test can help you determine if you're a good candidate. Here's how it works:

• Answer 12-14 questions about your eyes and health.

• A personalized report is generated in your browser window.

• The information you supply is completely confidential.

TAKE OUR FREE LASIK SELF EVALUATION RIGHT HERE, AND GET YOUR RESULTS RIGHT NOW!

1. DO YOU HAVE TROUBLE SEEING FAR- AWAY OR UP - CLOSE?

Far- away        Up -close       Both

2. WHAT IS YOUR AGE?

Below 19 years        Above 19 years

3. DO YOU CURRENTLY USE ANY OF THE FOLLOWING CORRECTIVE LENSES?

Spectacles       Contact lenses

4. DO YOU HAVE ASTIGMATISM?

Yes       No       No Idea

5. ARE YOU PREGNANT OR NURSING ?

Yes       No

6. HOW INTERESTED ARE YOU IN BEING ABLE TO PLAY SPORTS WITHOUT SPECTACLES OR CONTACTS?

Very much interested    Not of much interest

7. YES, I WOULD LIKE TO SCHEDULE A FREE EXAM OR EYE EXAMINATION . THE BEST TIME TO CALL ME IS

9am-12pm       12pm-4pm       4pm-7pm

PLEASE PROVIDE US WITH THE FOLLOWING CONTACT INFORMATION SO THAT OUR EXECUTIVE CAN GET IN TOUCH WITH YOU AT YOUR CONVENIENT TIME MENTIONED

Mr Ms    Name:      Mobile:    E -Mail Id:

WOULD YOU LIKE TO RECEIVE A FREE LASIK INFO KIT?

Yes    No