Request More LASIK Information from Saddleback Eye Center

Please provide us with your contact information, and then answer the questions below to find out if you are a good candidate for LASIK.

Name*

First Last

Email*

Phone*

Birth Year*

Without my glasses or contact lenses: (Please check all that apply)*

I have difficulty reading and seeing things up close (menu, cell phone, etc)
I have difficulty driving and seeing distance objects (street signs, watching TV)
I have difficulty reading and have noticed my distance vision is not as good as is used to be

What types of eyewear do you currently use? (Please check all that apply)*

Do you have any of the following conditions?   