Is laser eye surgery right for you?

Please fill the form and get answer till:
2018-07-24, Tuesday, 16:00

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1 EYESIGHT
2 HEALTH
3 REQUEST
Do you wear glasses?
Left eye - please specify the power (diopters) of your glasses, If don't know, leave empty...
0 /
Right eye - please specify the power (diopters) of your glasses, If don't know, leave empty...
0 /
Do you wear lenses?
Left eye - please specify the power (diopters) of your lenses, If not sure, leave empty...
0 /
Right eye - please specify the power (diopters) of your lenses, If not sure, leave empty...
0 /
Do you use any kind of medications every day (drops, tablets, etc.)?
If yes, specify what:
0 /
Had you any kind of surgery (operation) before?
If yes, specify what:
0 /
Allergies / Special Health Considerations?
If yes, specify what:
0 /
Do you plan surgery in near future?
According to your data, our specialists will give you initial answer if laser vision correction is suitable for you. If eye surgery is the appropriate option, we will invite you for the consultation and full eye examination.
Preferable appointment date
Name
Gender (sex)
Are you pregnant or are you breastfeeding now?
Phone number
Ageyour full name
Commentsmore details
0 /
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