LASIK Self-Test

Take our quick, free test to see if you’re a candidate for Kelly Lasik. One of our vision care specialists will be in touch with your results.

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What is your age? * This field is required.

Are you interested in seeing well up close (reading) without glasses? * This field is required.

Do you have trouble seeing far away or up close? (Select all that apply) * This field is required.

I usually wear (select all that apply) * This field is required.

First Name * This field is required.

Last Name * This field is required.

Phone * This field is required.

Email * This field is required.

* The answers to these questions will give us a general guideline as to your candidacy and expected outcome, the results of which we will provide. The only way to know the condition of your eyes is a thorough a lasik medical examination.

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By completing this form, you are giving us permission to follow-up by phone, email or text. This field is required.

By completing this form, you are giving us permission to follow-up by phone, email or text.

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