As with all techniques to improve or correct vision, there are usually certain limitations which prevent someone from benefitting from the procedure. With OCCLASIK using advanced LASIK technology, as long as you’re at least 21 years old and in good health, you’re most likely a great candidate. Through comprehensive eye exams at our clinic we will be able to inform you if you meet the basic requirements, and even if you are nearsighted, farsighted, or have astigmatism, you should still be eligible for LASIK!

Fill this form in to find out if you are a candidate for Laser Eye Surgery:

We recognize that your eyes are very important to you. We would like to know how you use your eyes on a daily basis. Along with your eye exam, this info will assist us in recommending the best options for your eyes and your personal lifestyle vision.


First Name *

Last Name *

Email *

Date of birth



Do you need corrective lenses to improve your distance vision?

Do you use reading glasses?

Do you wear contacts?

If so, please select the type of contacts you wear:

How long have you been wearing contacts?

When was the last day contacts touched your eyes?

Do you wear them overnight?

Has your prescription been stable over the last two years?

Please check any other reasons for problems with glasses or contacts:

Do you have an eye doctor you visit on a regular basis?

If yes, please list name and locations:

When was your last eye exam?

Do you have copies of your last prescriptions?

How did you hear about us? *



Download our Refractive Surgery Questionnaire