LASIK Self-Evaluation Test – Eye MD Monterey First Name* Last Name* E-mail* Phone* Age: Under 21 21 - 40 40 - 69 69+ Do you have trouble seeing far or close? Up close Far away Both What is your current method of vision correction? Glasses Soft contact lenses Toric soft contact lenses Gas permeable lenses Is seeing well up close (e.g., reading) without glasses important? 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/business improve without glasses? Yes No Maybe Do you know your visual prescription? Is your vision 20/20 with correcetive eyewear? Over 98 percent of LASIK patients see 20/40 or better after surgery. The results of LASIK laser vision correction have been tremendous for literally millions of people. Despite the amazing safety and results of this procedure, there are associated risks. Are you willing to discuss these risks with Dr. Penrose? How did you hear about us? Family or friend referred meRadioInternetNewspaperI am currently a patient