LASIK Excimer Laser Customized Correction LASIK & IntraLase Other Refractive Options Your LASIK Team LASIK Results Your Consultation Your Surgery Post Surgery Am I a candidate?   PATIENT SERVICES OCB Optical Make an Appointment Order Contacts Refill Prescriptions Change Patient Info Info by Mail New Patient Registration Patient Satisfaction Homepage Online LASIK Evaluation Answer the following questions and then press "Submit" at the bottom of the form to find out whether you are a good candidate for LASIK surgery. Your answer will be emailed to you shortly. (Please note: ALL questions must be answered to complete this test.) Is your eye prescription stable? Has it been the same for at least one year? YES   NO Are you 21 years of age or older? YES   NO Would you like to have the freedom from dependency on your glasses or contact lenses? YES   NO Do you have any corneal diseases such as keratoconus or herpes infection of the eye? YES   NO Do you have an autoimmune disease? YES   NO Are you currently pregnant or planning to become pregnant? YES   NO Are you known to form excessive scar tissue (keloids)? YES   NO Send answer to Email: My name is: City/State:

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