Am I Suitable For Laser Eye Surgery

1. Do you have trouble seeing far away or up close without an optical aid?
(tick more than one if needed)*
1. Do you have trouble seeing far away or up close without an optical aid?(tick more than one if needed)
- Up close
  (reading)
- Far away
  (TV, Driving)
- Intermediate
  (computers)
2. What optical aid do you use for correcting your vision currently ?
2. What optical aid do you use for correcting your vision currently ?
- None
- Glasses
- Soft contact
  lenses
- Toric soft
  contact lenses
- Gas permeable
  lenses
- Ortho-K
  lenses
3. What is your age?
- Under 18
- 18-20
- 21-39
- 40-49
- 50-54
- 55+
4. 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.
5. To understand your visual needs, could you please tell us your occupation

Permission to store your information

To communicate with you we need to store your contact information and will do so securely. You can always contact us whenever you wish to have this removed.
Transmitting this information, you agree to our Terms and Conditions of communication. To view these terms click or tap on the link and they will be displayed in a new tab or window.
Do you permit us to store your data*
- Yes
- No
Permission to contact you

We would like to send you eye related information from Centre for Sight by email or post. We shall always treat your personal details with utmost care, never passing them on to other companies for any reason.
Please let us know if you would like us to contact you or not by selecting one of the options below.*
- Yes please, I’d like to hear about eye care updates and news
- No thanks, I don’t want to hear about eye care updates and news
Name
This field is for validation purposes and should be left unchanged.

Am I suitable