Lasik Evaluation Form

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

2) What is your age ?
Below 18 yearsAbove 18 years
3) What do you usually wear ?
GlassesContact LensesBothNothing Yet
4) Has your glasses or contact lens prescription changed over the past year or two ?
YesNo
5) Have you ever had an eye injury or eye surgery ?
YesNo
FULL NAME

EMAIL

MOBILE

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 0161-4609810 for appointment scheduling.
For any further LASIK enquiry, you can directly connect with our executives at: 95018 32474/98157 02474/92168 02474.​