Dr. Michael B. Raizman - Ophthalmic Consultants of Boston

EYE CONDITIONS

LASIK

LASIK

PATIENT SERVICES

Online LASIK Evaluation

Answer the following questions and then press "Submit" at the bottom of the form to find out whether you are a good candidate for LASIK surgery. Your answer will be emailed to you shortly. (Please note: ALL questions must be answered to complete this test.)

Is your eye prescription stable? Has it been the same for at least one year?	YES NO
Are you 21 years of age or older?	YES NO
Would you like to have the freedom from dependency on your glasses or contact lenses?	YES NO
Do you have any corneal diseases such as keratoconus or herpes infection of the eye?	YES NO
Do you have an autoimmune disease?	YES NO
Are you currently pregnant or planning to become pregnant?	YES NO
Are you known to form excessive scar tissue (keloids)?	YES NO

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