LASIK, is it right for me?Which eye condition applies to you? Short Sighted Long Sighted Astigmatism Multi-Focals CataractsHow old are you?*Select your age group from the list18 to 2525 to 3535 to 4545 to 5555 to 6565 or olderAre you in good general health?Select your option as Yes or NoYesNoDo you have or want to have an active outdoor lifestyle?Select your option from the listYesNoI prefer to readHas your distance spectacle prescription changed significantly in the last 2 years?Select your option from the listYesNoOnly my reading requirementsDo you usually wear glasses or contact lenses?I need glasses for distance/driving visionI have reading glasses onlyI have glasses for distance and readingSoft contact lenses are worn most or all of the timeHard contact lenses worn every dayI don't have any glassesWhich of the following do you have?Myopia (nearsightedness; trouble seeing distance only)Hyperopia (farsightedness; trouble seeing both distance and near)AstigmatismPresbyopia (reading difficulties of middle-age)My vision is blurred even with glassesCataractsDon't knowDo you suffer from any of the following medical conditions?None - I am healthyDiabetesRheumatoid arthritisAutoimmune disease such as lupusMultiple SclerosisCollagen vascular diseaseI am currently pregnantOtherHave you been diagnosed with any of these eye conditions?None of these conditionsKeratoconusGlaucomaCataractsRetinal diseaseSevere dry eyeCorneal scarringLazy eyeOtherDo you currently take any medications that may slow your healing (such as steroids or immunosuppressant drugs)?Select your option as Yes or NoYesNoHave you been told that you are NOT a good candidate for LASIK surgery? (We can tell you about other options.)Select your option as Yes or NoYesNoHave you previously had eye surgery?Select your option as Yes or NoYesNoWhat is your biggest concern about having LASIK surgery?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?As soon as possibleWithin the next 3 months3 to 6 months6 months or moreNext yearI'm not sureWould you like more information or to book a consultation?Select your option from the listInformation onlyBook a free consultation at SubiacoBook a consultation with Dr Phil at MurdochBook a consultation with Dr Phil at SubiacoWhat is the MAIN reason you are interested in LASIK eye surgery? I want to be independent of visual aids Glasses or contact lenses are uncomfortable Sports or outdoors leisure activities, including watersports Work requirements Safety Career or job change requires better unaided vision Improved cosmetic appearanceHow did you hear about Perth Laser Vision?*Search EngineFamily/FriendRadio 92.9Radio 94.5NewspaperOnline Banner AdOptometristsYellowpagesEnter Your Name*Enter Your Email* Phone Number*Write Your MessageSecurity Code This iframe contains the logic required to handle Ajax powered Gravity Forms.