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Eye MD on Cass | Committed to the Health of Your Eyes

831.324.4730

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- Philip J. Penrose, MD
- Jennifer Sablad, OD
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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?

Eye MD Monterey Email: eyemdoncass@gmail.com $
880 Cass Street Suite 105
Monterey, CA 93940
P: (831) 373-0183
F: (831) 886-3366
Eye MD at Ryan Ranch $
21 Upper Ragsdale Drive Suite 201
Monterey, CA 93940
P: (831) 324-4730
F: (831) 886-3366

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