Laser Suitability Test

What is your age? *

0-21 years22-47 years48+ years

Do you know your prescription or how you see? *

Mildly shortsighted (-0.25 to -2.00)
I can see well up close, but small details in the distance are blurry.Moderately shortsighted (-2.25 to -7.00)
I can see well up close, but larger objects in the distance look blurry.Highly shortsighted (-7.25 to -20.00)
I only see clearly when things are very close to me.Astigmatism
Everything is blurred if I don’t wear glasses or contact lenses.Mildly longsighted (+0.25 to +2.00)
I see distant objects clearly, but reading or close work is blurry.Highly longsighted (+2.25 or more)
I see distant objects but they are clearer with glasses on, but I struggle with anything within arm’s lengthNot sure
I’m unsure of my prescription.

Please select the option that best describes your daily activities and lifestyle *

I work with a screen more than 8 hours a dayI play contact sports, engage in physical activities, and/or swim regularlyMy job requires specific vision standards (e.g. pilots, firemen, police)None of the above

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