Request For Information For LASIK | Best LASIK 2021

For more information about LASIK, please complete the form below or contact us at 877-351-3937. By submitting this form, you will be contacted by a patient counselor at Saddleback Eye Center who will provide you with more information about LASIK.

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)*
- Contact lenses
- Prescription eyeglasses
- Over the counter reading glasses
- None of the above
Do you have any of the following conditions?   
- Cataracts
- Keratoconus
- Glaucoma
- Previous refractive eye surgery
- Previous eye injury
- Currently pregnant
- None of the above
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