1. Do you have trouble seeing far away or close?
2. What do you currently use to correct your vision?
3. What is your age?
4. Do your glasses and contacts interfere with recreational or daily activities?
5. What is your main concern with Laser Vision correction?
6. What are your primary reasons for wanting vision correction?
7. Have you had a vision correction consultation before?
8. If you are a candidate, are you interested in a Free LASIK Consultation?
9. How did you hear about us?
10. Where would you like the results & information sent to?