This form is designed to obtain similar information from you that we would obtain during your office visit. This form will also help determine if you are a good candidate for LASIK.
Please note that all fields with a red * next to them are required in order to submit the form properly. Thank you.
Ocular History :
Please check the comment that best describes you for each of the following:
1. Activities I enjoy:
2. Please indicate your level of interest in laser vision correction:
3. Why are you interested in laser vision correction:
4. How did you hear about Ohio Valley Eye Institute?
(Please check all that apply)
5. How did you find our On-line Consultation?
6. What type of vision insurance do you have?