lasik self test

Dougherty Laser Vision offers a wide range of vision correction and refractive surgery procedures. With four locations to choose from, our specially trained staff will advise you on which procedure will best suit your vision needs. To learn more about what you’re a candidate for, please complete the self evaluation below. One of our vision coordinators will be in contact once complete. Please fill out as many answers as possible.

  • What is your age group?
  • I most often wear:
  • Without my glasses and contacts...(check all that apply)
  • "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.
  • "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.
  • If you are a candidate, how soon would you like to improve your vision?
  • Drop files here or
    Accepted file types: jpg, png, jpeg, pdf.
    Please upload an image of your insurance card and prescription information.
    Maximum file size - 12 mega bytes.