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Dr. Alan Barber
Dr. Michael Bollenbacher
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Dr. Chandni Merchant
Dr. Robert E. Prouty
Dr. Sumit A Sitole
Dr. Richard Stewart
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Locations
Services
Cataracts
LASIK and PRK
ICL
Glaucoma
Corneal Cross Linking
Cornea
Presbyopia
Clear Lens Exchange
Advanced Dry Eye
Patient Information
Request an Appointment
New Patient Forms
Patient Financing
Insurance Information
Our Doctors
Team
Dr. Alan Barber
Dr. Michael Bollenbacher
Dr. Teresa Carlson
Dr. Thomas Cruse
Dr. Isha Gupta
Dr. C. Starck Johnson
Dr. Crystal Kasper
Dr. Ketty Lee
Dr. Chandni Merchant
Dr. Robert E. Prouty
Dr. Sumit A Sitole
Dr. Richard Stewart
Dr. Carl Tubbs
Locations
InSight Vision Group Parker
InSight LASIK Parker
InSight Vision Group Denver
InSight Vision Group Boulder
InSight LASIK Boulder
InSight Vision Group Longmont
InSight Vision Group Fort Collins
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Preferred Date
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Are you a current patient?
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First Name
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Last Name
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Phone Number
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Email Address
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Preferred Location
InSight Parker
InSight Denver
InSight Boulder
InSight Longmont
InSight Fort Collins
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)
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LASIK Candidacy Survey
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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?
Which location would you prefer?
*
LASIK Parker Office
LASIK Boulder Office
What Age Group Are You In?
*
Under 18 Years Old
19-39 Years Old
40-59 Years Old
60+
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