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LASIK & Vision Correction
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Newbury Rd, Thousand Oaks
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LASIK Qualifications
LASIK
>
LASIK Qualifications
Sub Title
LASIK Self-Test
Name
Email
Phone
What is your age group?
Under 18
19-39
40-59
60+
I most often wear:
Glasses
Contacts
Readers
Bifocals/Trifocals
I do not currently wear corrective lenses
Without my glasses and contacts...(check all that apply
Farsightedness: I have trouble reading and seeing things up close
Nearsightedness: I have trouble driving and seeing things far away
Astigmatism: I have distorted vision and cannot see very well
I would like to see well at a distance without relying on glasses and contact lenses.
Rate this statement on a scale of 1 to 5 with 1 being the lowest.
1
2
3
4
5
I would like to see well up close without relying on glasses and contact lenses
Rate this statement on a scale of 1 to 5 with 1 being the lowest.
1
2
3
4
5
If you are a candidate, how soon would you like to improve your vision?
As soon as possible!
In the next few weeks
In the next few months
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Westlake Village
Camarillo
Simi Valley
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Ventura
Newbury Park
DLV Surgical Center
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(805) 987-5300
818-874-3048
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