Boulder & Longmont
:
303-402-1000
Arvada, Denver, & Parker:
303-794-1111
Littleton:
303-991-9662
Provider Portal
LASIK Survey
Appointments
Call Us
Contact
Provider Portal
Our Doctors
Patients
Insurance Information
Patient Financing
Patient Forms
Request an Appointment
Testimonials
Locations
InSight Vision Group Arvada
InSight LASIK Boulder
InSight Vision Group Boulder
InSight Vision Group Denver – Yale
InSight Vision Group Littleton
InSight Vision Group Longmont
InSight LASIK Parker near Lone Tree
InSight Vision Group Parker near Lone Tree
Services
Advanced Dry Eye
Cataracts
Clear Lens Exchange
Cornea
Corneal Cross Linking
Glaucoma
ICL
LASIK and PRK
Presbyopia
Contact
Contact Us
Careers
Providers
Provider Forms
Provider Portal
Residency Program
Schedule an Appointment
×
Preferred Date
*
Are you a current patient?
*
Yes
No
First Name
*
Last Name
*
Phone Number
*
Email Address
*
Date of Birth
Preferred Location
*
InSight Parker
InSight Denver - Yale
InSight Boulder
InSight Littleton
InSight Longmont
InSight Arvada
InSight LASIK South
InSight LASIK North
I currently wear (check as many that apply)
Soft Contacts
Gas Permeable Contacts
Glasses
Readers
I am
Nearsighted
Farsighted
Astigmatic
Please describe the nature of your appointment (e.g., consultation, check-up, etc)
*
Submit
LASIK Candidacy Survey
×
Please complete the following questions to help us provide you with an appropriate response.
First Name
*
Last Name
*
Email Address
*
Phone Number
*
Who is your current eye doctor?
Date of Birth
Which location would you prefer?
*
LASIK Parker Office
LASIK Boulder Office
I wear glasses and contacts because (check all that apply)
I have trouble reading and seeing things up close
I have trouble driving and seeing things far away
I have astigmatism
What do you usually wear (check all that apply)
Glasses
Contacts
Reading Glasses
I don't wear correction and probably should
Have you ever had (check all that apply)
Previous Eye Surgery
A serious eye injury
Cataracts
Keratoconus
Diabetic Retinopathy
Where do you live your visual life (check all that apply)
I love the outdoors and am active
I love reading
I love participating in sports
I spend hours on my computer
What are your expectations after LASIK? (check all that apply)
I am fine wearing glasses for distance
I do not want to wear glasses for distance
I am fine wearing glasses for up close and reading
I do not want to wear glasses for seeing up close
Would you be willing to review your level of candidacy with one of our InSight LASIK Counselors?
*
Yes
No
Submit