LASIK Test Oregon | LASIK Doctors Oregon

Self Evaluation Test

Name:
Phone:
E-Mail:

Do you have trouble seeing far away or up close?
Up close

Far away
How interested are you in being able to play sports without glasses and contacts?
It's very important to me NOT to wear glasses for activities such as sports.

It's not important to me. I do not mind wearing glasses.
What is your age?
Under 21

21 - 40

40 - 69

69+
Are you interested in seeing well up close (reading) without glasses?
It's very important to me NOT to wear reading glasses.

It's not important to me. I do not mind wearing reading glasses to see things up close.
Do you wear contact lenses or glasses?
Glasses

Contact lenses
Would your career or business activities improve if you were to become less dependent on glasses and contacts?
Yes

No

Maybe
Over 98% of LASIK patients see 20/40 or better after surgery. The results of LASIK laser vision correction have been tremendous for literally millions of people. Despite the amazing safety and results of this procedure there are associated risks. Are you willing to discuss these risks with our LASIK coordinator?
Yes

No
Please select your preferred location for submission
Northwest

Southeast

Oregon City/Milwaukie

9555 SW Barnes Rd. # 201 Portland, OR 97225 Phone: 503-227-2020 |12050 SE Stevens Rd, Happy Valley, OR 97086 Phone: 971-206-6100 |24601 SE Stark St. Troutdale, OR 97060 Phone: 503-261-7262 |15963 SE Happy Valley Town Center Dr Happy Valley, OR 97086 Phone: 503-525-2737 |Orenco Station 6111 NE Cornell Rd., Hillsboro, OR 97124 Phone: 503-227-2020 |King City 15405 SW 116th Ave. Portland, OR 97224 Phone: 503-227-2020 |Milwaukie 11086 SE Oak St. Portland, OR 97222 Phone: 503-557-4775 |3246 N. Lombard St. Portland, OR 97217 Phone: 503-227-2020 |5050 NE Hoyt St. Portland, OR 97213 Phone: 503-261-7262 |1955 NW Northrup St. Portland, OR 97209 Phone: 503-227-2020 |1306 Division St. Oregon City, OR 97045 Phone: 503-557-4775 |10819 SE Stark St. Portland, OR 97216 Phone: 503-261-7262 |13240 SW Pacific Hwy Portland, OR 97223 Phone: 503-639-6571 |

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