When you fill this test we will be able to make an initial assessment of whether you are a suitable candidate for laser vision correction. Of course, this questionnaire does not replace the medical examination, but your answers will help us to specify your individual needs.


How old are you?

Gender:

Do you have problems with near vision or distance vision?

Do you wear glasses or contact lenses?

Have you changed the dioptres during the last one year?

Your disease is:

The main reason considering laser vision correction is:

In terms of activities / profession do you have explicit vision related instructions?

Do you want good near vision (to read) without glasses?

Do you suffer from any of the following diseases:

Do you suffer from any the following diseases:

Currently do you take drugs such as steroids or immunosuppressive drugs?

Currently are you pregnant / do you plan pregnancy in the near future?