One Minute LASIK Quiz Take the Quiz to Earn a $400 LASIK Coupon *Restrictions Apply* What is your age range?*18 to 2930 to 3940 to 4950 to 5960 or OlderI usually wear (check all that apply)* Glasses Contacts Readers Bifocals/trifocals Do your glasses or contacts interfere with recreational activities?*YesNoWithout glasses or contacts (check all that apply):* I have trouble seeing distance I have trouble reading I've been told I have astigmatism How well do you see at night?*Very wellOk, but could do betterPoorlyWhat are your main concerns with LASIK? (Check all that Apply)* Affordability Convenience Safety Experience of Doctor Other Have you had a LASIK evaluation before?*YesNoIf you are a LASIK candidate, when would you like to have the procedure?*Within one monthTwo to six monthsSix months or moreName* First Last Email NameThis field is for validation purposes and should be left unchanged.