LASIK Eye Test - Precision Eye Institute

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303 N. Ridgewood Ave. Edgewater, FL 32132
(386) 424-1422
424 Luna Bella Lane - Suite 127, New Smyrna Beach, FL 32168
(386) 957-3715
2638 LPGA Blvd.(Publix Plaza) Daytona Beach, FL 32124
(386) 271-3070

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Home
Vision Correction Procedures
Eye Care Services
Testimonials
Patient Resources
Our Blog
About
- Meet the Doctors
- Careers
Contact

Menu

Home
Vision Correction Procedures
Eye Care Services
Testimonials
Patient Resources
Our Blog
About
- Meet the Doctors
- Careers
Contact

Self-Test for LASIK Surgery in New Smyrna Beach

- Step 1 of 11

Which of these do you wear most often? *

Glasses
Contacts
Readers
I do not use any of these

What is your age? *

15-40
40-60
60-100

When using your Glasses / Contacts or Readers, or if you do not wear any of these, do you have trouble seeing street signs? *

Yes
No

Have you been diagnosed with astigmatism? *

Yes
No

How is your vision at night? *

Very Good
Just Ok
Very Bad

Would your quality of life improve if you were less reliant on your contacts, glasses or readers? *

I think it would be much better
I do not think it would help
I think it may help

If LASIK is right for you, when would you like to have your procedure? *

Within a few weeks
Within a few months
More than 3 months from now

Name *

First

Last

Phone

Email *

Self-Test Complete
Thank you for using our Self-Test form, please submit your answers to see if you are a good candidate for Lasik Surgery.

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