LASIK Self-Test

Lasik Self-Test

What is your age?
I wear (choose all that apply):
Has your prescription changed over the last 2 years?
Are you currently nursing, pregnant, or planning to get pregnant in the near future?
What are you looking for in a LASIK Center? (choose all that apply):
Did your eye doctor talk to you about New Vision Laser Center?
I authorize a New Vision Laser Center representative to contact me to discuss the results of my LASIK Self-Test. I acknowledge that the information provided in this questionnaire will be used to send additional information about offers related to our services.(Required)
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