LASIK, is it right for me? "*" indicates required fields How old are you?* Do you have trouble seeing?*- Please Select -Far awayClose upBothHas your prescription changed significantly in the last 2 years?- Please Select -YesNoDo you usually wear glasses or contact lenses?*- Please Select -GlassesSoft contact lensesHard contact lensesBoth glasses and contact lensesI don’t wear anyHave you been diagnosed with any of these eye conditions?- Please Select -KerataconusCataractsGlaucomaRetinal diseaseSevere dry eyeCorneal scarringLazy eyeOtherWhich Other Eye Condition? Have you previously had eye surgery?- Please Select -YesNoPlease advise, which surgery you have had Do you suffer from any of the following medical conditions?- Please Select -None- I am healthyDiabetesRheumatoid arthritisAutoimmune diseases such as lupusMultiple SclerosisCollagen vascular diseaseI am currently pregnantHave you been told that you are NOT a good candidate for LASIK surgery?(We can tell you about other options.)- Please Select -YesNoWhat is your biggest concern about having LASIK surgery?- Please Select -No concernsMoving my eyes or head during laser treatmentExpenseAchieving the best vision possibleNeeding glasses or contacts againHaving to still wear reading glasses when I’m olderOtherHow soon would you like to improve your vision?Within the next 3 months3 to 6 monthsMore than 6 monthsI’m not sureWould you like more information or to book a consultation?*- Please Select -Information onlyBook a consultation with Dr Phil at MurdochBook a consultation with Dr Phil at SubiacoHow did you hear about Perth Laser Vision?*- Please Select -Family/friendGoogleFacebookRadioOnline Banner AdGPOptometristYour Contact DetailsFirst Name* Last Name* Email Address* Phone Number* Date of Birth DD slash MM slash YYYY Address* Street Address City Post Code Write Your Message