Download LASIK Evaluation Form - Laser Eye Center of Miami

You will be seen for a Free LASIK Evaluation to find out if you are a
candidate for any form of refractive surgery.
This is not a comprehensive exam and only includes vision with and
without correction, glasses measurement, auto refraction (preliminary
measurement of the refractive error of the eye), and undilated anterior segment
exam. This examination only intends to find if you fall within the general
guidelines of refractive surgery and answer any questions you might have about
it. You might still not be a candidate for refractive surgery if additional conditions
are found during more extensive ocular examination.
This type of exam does not entail the prescription of glasses, contact
lenses or any type of medications. It does not completely rule out other ocular
conditions that might cause vision loss. Everybody should have an annual eye
exam. You could have it done at our office or with your regular ophthalmologist.
I agree with the Terms and Conditions of the Free LASIK Evaluation as
stated above:
Patient: __________________________________
Date: ___________________