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1 Appointment
You must be over 18 years, have stable vision for one year, not be pregnant or breastfeeding. 

Did you have a free online consultation already?

It's easy to find out if laser vision correction is right to you as 1-2-3. 
Please fill the form and get answer  till: 2018-06-22, Friday, 16:00


1. Health
Do you wear glasses?

Please specify the power (diopters) of your glasses, If don't know, leave empty...

Left eye
0 /
Right eye
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Do you wear lenses?

Please specify the power (diopters) of your lenses, If don't know, leave empty...

Left eye
0 /
Right eye
0 /
Do you use any kind of medications every day (drops, tablets, etc.)?
Please, specify below
0 /
Had you any kind of surgery (operation) before?
Please, specify below
0 /
Allergies / Special Health Considerations?
Please, specify below
0 /

Do you plan surgery in near future?

Great, please choose appointment request for:
  • full eyes examination and laser vision correction;
  • or surgery only, if you already had a consultation.
During the consultation we may need to dilate your pupils which can limit the vision for a few hours (especially short and driving distances).

2. Appointments
If eye surgery is suitable for you, we will invite you for:
  • full eyes examination and laser vision correction at your convenience;
  • or consultation with full eyes examination only, if you have not decided surgery date yet.
During the consultation we may need to dilate your pupils which can limit the vision for a few hours (especially short and driving distances).

Appointment details for consultation

Clinic:
Date & time:

Appointment details for surgery

Clinic:
Date & time:

3. Contact details

Your Contact details

First name
Last name
Phone number
Your age
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