Am I Suitable for Eye Surgery?

Do you wear glasses or contact lenses?

What is your prescription for? ^*

Do you roughly know what your prescription is?

Please enter your age ^*

Has your prescription changed in the last 2 years? ^*

If you are suitable, how soon would you like to proceed with surgery? ^*

What are your main reasons for having Laser Vision Correction? ^*

Is there any additional information you think would be relevant (e.g. trauma, surgery, family history of eye conditions):

Your Name ^*

Your Email ^*

Your Phone ^*

How did you hear about us? ^*