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562-431-2748
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LASIK Quiz
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LASIK Quiz
LASIK Self-Test
"
*
" indicates required fields
Step
1
of
6
– Step One
16%
I most often wear:
*
Glasses
Contacts
Readers
None of these
What is your age range?
*
15-44
45-55
56-106
I've been told I have astigmatism
*
Yes
No
Without my glasses I have trouble reading street signs
*
Yes
No
Without my contacts I have trouble reading street signs
*
Yes
No
Without my readers I have trouble reading street signs
*
Yes
No
I have trouble seeing street signs
*
Yes
No
How well do you see at night?
*
Very Well
Ok, but could do better
Quite Poorly
Without my glasses I have trouble reading my cell phone
*
Yes
No
Without my contacts I have trouble reading my cell phone
*
Yes
No
Without my readers I have trouble reading my cell phone
*
Yes
No
I have trouble reading my cell phone
*
Yes
No
When choosing your vision correction surgeon, which matters to you?
*
Affordability
Safety
Convenience
Experience of the surgeon
Technology
Would your life improve if you were less dependent on glasses and contacts?
*
Absolutely!
No way.
Maybe?
If you are a candidate, when would you like to have your procedure?
*
Next few weeks
Next few months
>3 months out
Contact Info
First Name
*
Last Name
*
Phone
*
Email
*
By submitting this form, you understand that you will receive a phone call, email, and text message from Lucent Vision to help you get scheduled for your free consultation.
Make An Appointment
Meet Dr. Pathak
Procedures
Long Beach
LASIK
Lens Exchange
EVO ICL
SMILE
Cataracts
Fountain Valley
LASIK
Lens Exchange
EVO ICL
SMILE
Cataracts
Reviews
Patient Resources
Pay My Bill
Articles
Locations
Long Beach
Fountain Valley
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