Lasik Evaluation Form

1) Do you have trouble in seeing distance or nearby ? *

Distance Nearby Both

2) What is your age ? *

Below 18 years Above 18 years

3) What do you usually wear ? *

Glasses Contact Lenses Both Nothing Yet

4) Has your glasses or contact lens prescription changed over the past year or two ? *

Yes No

5) Have you ever had an eye injury or eye surgery ? *

Yes No

Name *

Email *

Mobile *

Enter The Code *

Shortly you will receive a call from our lasik expert. A thorough LASIK Evaluation would be required to know whether you are a good candidate for LASIK or not. Schedule your LASIK evaluation today, call on 0135-2717500/505 for appointment scheduling.