Lasik Candidacy Test LASIK CANDIDACY TEST

12 Harley Street, London, W1G 9PG

First Name: *

Your first step to a life without glasses or contact lenses is to learn whether or not you are a good candidate for laser vision correction. Please fill in the Self-Evaluation Test to your right to get started today. One of our qualified specialists will call you back.

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Do you wear glasses or contact lenses ? *	Yes No
Are you pregnant or nursing ? *	Yes No
Have your eyes been operated on before ? *	Yes No
Do you have diabetes or glaucoma?	Yes No
Prescription	Left Eye SPH (+ -) CYL (-) Right Eye SPH (+ -) CYL (+ -)

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