Am i suitable

Am I Suitable?

To better understand if you would be a good candidate please take a moment to complete the form below. Once your visual needs and lifestyle requirements have been determined, our ophthalmic assistant will be able to advise you on your suitability as well as what vision correction procedure might be applicable.

You may also schedule a free screening appointment to determine if you are a candidate. Call us on 011 485 3097

First Name*
Last Name*
Mobile Number
Secondary Telephone Number
What is the best time to contact you?*

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Email Address*
How did you hear about us?
Surgery Type
Laser Vision Surgery
Refractive errors typically do not stabilise until the late teens or early twenties. To be suitable for refractive surgery of any sort, you should be over 21 years of age with no change in your spectacle or contact lens prescription over the previous 2 years. To determine whether or not you are a candidate for Laser Vision Correction.
1. Do you have trouble seeing far away or up close without an optical aid?*
2. What optical aid do you use for correcting your vision currently ?*
3.What is your age?*
4. Are you interested in seeing well up close (reading) without glasses?*
5. To understand your visual needs, could you please tell us your occupation
6. Do you know your approximate visual prescription?*
7. Do you have astigmatism?*
8. Has your prescription been stable over the last two years?*
9. Do your eyes hurt after prolonged eyewear use?*
10. Are you prepared to undergo a 1-2 hour preoperative evaluation?*
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Am I Suitable?

Laser Vision Surgery