Odisha Lasik Centre
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Am I Suitable

Our surgeons at Odisha Lasik Centre want to help you determine whether or not you are a candidate for Laser Vision Correction. In order to better understand if you would be a good candidate please take a moment to complete the form below. Once your visual needs and lifestyle requirements have been determined our patient coordinators will be have a better idea of your suitability as well as what vision correction procedure(s) might be applicable.

Please fill the mandatory filed, So that we will get back to you as quick as possilble.

* Name
* Phone
* Email
What is your occupation ?
How did you here about us ?
What is the best time to contact you ?
What optical aid do you use for correcting your vision currently ?
Up close (reading)
Far away (TV, Driving)
Intermediate (computers)
What optical aid do you use for correcting your vision currently ?
Glasses
Soft contact lenses
Toric soft contact lenses
Gas permeable lenses
What optical aid do you use for correcting your vision currently ?
Less than 18
18-21
21-42
42-50
50-55
50+
Are you interested in seeing well up close (reading) without glasses?
It's very important to me NOT to wear reading glasses.
It's not important to me. I do not mind wearing reading glasses to see things up close.
Do you know your approximate visual prescription ?
Yes
No
Q6. Do you have astigmatism ?
Yes
No
Q7. Has your prescription been stable over the last two years ?
Yes
No
Q8. Do your eyes hurt after prolonged eyewear use ?
Yes
No
Q9. Are you prepared to undergo a 2 to 3 hour preoperative evaluation?
Yes
No