LASIK Self Test
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Email *
Name *
Date of birth *
MM
/
DD
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YYYY
Phone Number *
Do you have trouble seeing far away or up close *
Required
How interested are you in being able to play sports without glasses or contact lenses? *
It's not important to me. I don't mind wearing glasses or contacts.
It is very important to me NOT to wear glasses for sports activities.
Are you interested in seeing well up close (reading) without glasses? *
It is not very important to me. I don't mind wearing reading glasses.
It is very important to me NOT to wear reading glasses.
Would your career or business activities improve if you were to become less dependent on glasses and/or contact lenses? *
Do you primarily wear contact lenses or glasses? *
What is your age? *
Would you like to be contacted by Fry Eye Associates to schedule a LASIK consultation? *
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