Online Suitability Assessment

Are you a candidate for laser vision correction?

Your journey to visual freedom begins with an initial online assessment where we will determine if you are a suitable candidate for a laser vision correction procedure.

Please complete the form below and one of our friendly team will be in touch regarding whether you are a potential candidate and next steps.

Add form fields:

First Name.   Last Name

Email

Phone

Do you wear contact lenses (please state type) or glasses or both?

(Check boxes or radio buttons)

• Contacts IF selected then….
  • Type of lenses
    Near
    Far
    Mixed
• Glasses
• Both glasses and contacts IF selected then….
  • Type of contact lenses
    Near
    Far
    Mixed

What is your age? Check boxes or radio buttons

• 20-30
• 30-40
• 40-50
• Over 50

Has your script been stable over the last 12 months? Yes / No

Have you undergone laser vision correction previously? Yes / No

Do you suffer from Dry eyes? Yes / No

Where applicable, are you pregnant or breastfeeding? Yes / No

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Onscreen confirmation:

Thank you for submitting your assessment. One of our team will be in touch to schedule a video consultation to discuss your options.

If you selected ‘Yes’, that you are currently pregnant or breastfeeding, unfortunately you are not a suitable candidate for laser vision correction at this time.