Self-Test

See if You're A Candidate!

Some basic clinical information can help us determine your LASIK candidacy

LASIK Self-Test

Thank you for your interest in LASIK at Louisiana Eye & Laser! To help us with scheduling your FREE LASIK screening, please complete this self-test to help us determine if you are a candidate for LASIK.

Name (First / Last)

Phone

Do you prefer a phone call or a text?

Best time to reach you by phone or text?

What is your age range?

Do you have trouble seeing far away or up close?

I usually wear (check all that apply):

Are you interested in seeing well up close (reading) without glasses or contacts?

Would your career or business activities improve if you were less dependent on glasses or contacts?

What is your main concern about LASIK?

Over 98% of LASIK patients see 20/40 or better after surgery. The results of LASIK laser vision correction have been tremendous for literally millions of people. Despite the amazing safety and results of this procedure there are associated risks. Are you willing to discuss these risks with our LASIK coordinator?

Preferred date for FREE LASIK Consultation

I Accept the Terms of Use*

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Self-Test

See if You're A Candidate!

Some basic clinical information can help us determine your LASIK candidacy

LASIK Self-Test

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