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Dr. Michael Pernula
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Book Now
702-724-2020
Services
LASIK
Dry Eye
Reading Vision
Cataract
Comprehensive Eye Care
Children’s Eye Care
Glaucoma
AMD
Eye Diseases Caused by Diabetes
Blepharoplasty
Ectropion and Entropion Repair
Eyelid Tumors
Ptosis Repair
About Us
Locations
Our Doctors
Dr. Eva Liang
Dr. Michael Pernula
Dr. Jeffrey Hart
Dr. W. Reed Jaussi
Dr. Adam Schwartz
Dr. Tina Licina
Dr. George Bouras
Dr. Selim T. Koseoglu
Dr. Jeylan El-Mansoury
Dr. Dennis Giang
Dr. Stewart Park
Dr. Sahba Fakhra
Dr. Sylvia Chang
Patient Stories
Research & Clinical Trials
Blog
COVID Notice
Financing
Careers
Contact
Patient Portal
New Patient Paperwork
Patient Referrals
LASIK Candidacy Test
Home
»
LASIK Candidacy Test
LASIK Candidacy Test
Do you wear glasses or contact lenses most of the time?
Glasses
Contacts
Are you in good general health?
Yes
No
Have you ever had a serious eye injury or eye surgery?
Yes
No
Have you ever had a herpes infection on your cornea?
Yes
No
Do you take any of these medications: Accutane®, Cordarone®, Methotrexate, Embrel®, Plaquenil®, or Gilenya®?
Yes
No
Are you pregnant or nursing?
Yes
No
Do you have any of the following vision problems?
Myopia (nearsightedness)
Hyperopia (farsightedness)
Astigmatism
None or Not Sure
How would you rate your quality of night vision?
Good
Fair
Poor
Do you currently require reading glasses or bifocals?
Yes
No
Which is the most important issue for you regarding LASIK?
Results
Affordability
Safety
Do you know studies show you have as much as 10 times greater risk contracting a sight-threatening infection from wearing contacts than from getting LASIK?
Yes
No
Do you have any autoimmune disorder?
Yes
No
Name
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How did you hear about us?
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Do we have permission to text you?
*
Yes
No
Would you like our office to follow-up with you to schedule a free LASIK evaluation?
Yes
No
Next:
What Technology Is Used During LASIK?
What are the benefits of LASIK?
Am I a candidate for LASIK?
LASIK Candidacy Test
What technologies are used during LASIK?
Who performs the procedure?
What happens on the day of procedure?
When can I return to normal activities after LASIK?
How well will I see after LASIK?
Are there any risks ?
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