Eye Surgeon Associates
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If you have an eye issue/medical concern, that needs attention right away, please don’t leave a message. Call any of our offices during office hours or our after hours number (563) 328 - 5103 for immediate attention or go directly to an emergency room.
LASIK Self Evaluation Test

Your answers will be sent directly to our Refractive Coordinator who will contact you shortly to clarify any points that need more discussion and let you know if it appears as though LASIK will work for you. The only way to be certain whether LASIK can work for you is to complete our free LASIK Consultation which our Coordinator can schedule for you. Be sure to include a phone number and email address where we can contact you. Thank you for your interest in Eye Surgeons Associates.

  1. Are you in good general Health?
  2. Have you ever had an eye injury or eye surgery?
  3. Do you have trouble seeing:
  4. Do you know your visual prescription? (select from drop down)
      SPH
    (+-)    		 CYL
    (-)
      SPH
    (+-)    		 CYL
    (-)
  5. Do you currently use corrective lenses?
  6. Do you have an astigmatism?
  7. How interested are you in being able to play sports without glasses or contacts?
  8. Would your career or business activities improve if you were to become less dependent on glasses and contacts?
  9. Are you interested in seeing well up close (reading) without glasses?
  10. How would you like to be contacted?

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The information provided on this web site is for informational purposes only.
The information is not intended to be a provision of medical care and
does not create a physician patient relationship.
This website is for informational purposes only, and is not intended to be medical advice.