Welcome to Buena Vista Laser Center’s LASIK Self-exam. We invite you to complete the following questionnaire in order to determine your candidacy for LASIK surgery. Let’s begin your journey to better vision.

Start by entering your name. Then click "next."

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- Step 1 of 10

Name *

First

Last

Phone *

Your Age *

18 and Under
19 - 39
40 - 59
60+

Without my Glasses or Contacts *

I have trouble reading and seeing up close
I have trouble driving and seeing far away
I have Astigmatism

What do you usually wear? *

Glasses
Reading Glasses
Contacts

Do you have any of the following? *

Rheumatoid Arthritis
Multiple Sclerosis
Lupus
Cataracts
Keratoconus
Diabetic Retinopathy
Prior Eye Surgery
Prior serious eye injury
I am currently pregnant
None of the above

How interested are you in being able to enjoy outdoor activities and/or sports without glasses and contacts? *

It's very important to me NOT to wear glasses for outdoor activities and/or sports
It's not important to me. I do not mind wearing glasses

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

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

Yes
No
Maybe

What email should we send the results to? *

Thank You

Useful links

Contact info

(915) 333-5555

[email protected]

1300 Murchison Dr Ste 315 El Paso, TX 79902

LASIK Candidacy Test

www.eplasik.com

Start by entering your name. Then click "next."