LASIK Self-test – Waite Vision

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Step 1 of 6 - Step One

16%

I most often wear:*

Glasses

Contacts

Readers

None of these

What is your age range?*

15-44

45-55

56-106

I've been told I have astigmatism*

Yes

Without my glasses I have trouble reading street signs*

Yes

Without my contacts I have trouble reading street signs*

Yes

Without my readers I have trouble reading street signs*

Yes

I have trouble seeing street signs*

Yes

How well do you see at night?*

Very Well

Ok, but could do better

Quite Poorly

Without my glasses I have trouble reading my cell phone*

Yes

Without my contacts I have trouble reading my cell phone*

Yes

Without my readers I have trouble reading my cell phone*

Yes

I have trouble reading my cell phone*

Yes

When choosing your vision correction surgeon, which matters to you?*

Affordability

Safety

Convenience

Experience of the surgeon

Technology

Would your life improve if you were less dependent on glasses and contacts?*

Absolutely!

No way.

Maybe?

If you are a candidate, when would you like to have your procedure?*

Next few weeks

Next few months

>3 months out

Contact Info

First Name*

Last Name*

Phone*

Email*

By submitting this form, you understand that you will receive a phone call, email, and text message from Waite Vision to help you get scheduled for your Waite Vision Ocular Analysis.

By checking this box you agree to receive text messages from Waite Vision; Reply STOP to opt out; Reply HELP for help; Message frequency varies; Message and data rates may apply; Carriers are not liable for delayed or undelivered messages

I agree

Complete Evaluation

2 hours • $150

This small investment goes towards your vision correction procedure. This visit is our most comprehensive eye exam.

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Appointment Notes or Questions

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