Are you ready for LASIK? LASIK Self Evaluation Test Whether or not LASIK is right for your eyes can only be determined by a comprehensive consultation, provided free at The Eye Clinic Surgicenter. But if you’re curious whether you’re in the ballpark for 20/20 vision without lenses, take our free LASIK Self Evaluation. 1 Self Evaluation 2 Contact Information Do you have trouble seeing far away or up close? *Up CloseFar AwayWhat is your age?*under 1818-2121-4040-6060+Are you interested in seeing well up close (reading) without glasses? * It's very important to me NOT to wear reading glasses. It's not important to me. I do not mind wearing reading glasses to see things up close. Do you currently wear contact lenses or glasses? *Glasses Contact LensesWould your career or business activities improve if you were to become less dependent on glasses and contacts? *YesNoMaybeIf you are a candidate, when would you be interested in taking the next step? Right Away3-6 MonthsOtherHow did you hear about us?*Existing PatientDr Referral Word of MouthAdvertisement (Radio/Newspaper)GoogleBingFacebookOther Name*FirstLastPhone*We will not add your number to a call list or call you unless you request a consultation at the end of the evaluation. Email*Would you like to be added to our Email List for coupons and other offers?*YesNoNameThis field is for validation purposes and should be left unchanged.