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Dr. Michael Bollenbacher
Dr. Teresa Carlson
Dr. Howard Amiel
Dr. Thomas Cruse
Dr Heather Gitchell
Dr. Isha Gupta
Dr. Shipra Gupta
Dr. C. Starck Johnson
Dr. Crystal Kasper
Dr. Ketty Lee
Dr. Sumit A Sitole
Dr. Richard Stewart
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Research Shows Patients Who Have Cataracts Removed are 30% Less Likely to Develop Dementia
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InSight Vision Group Parker near Lone Tree
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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
*
Phone Number
*
Email Address
*
Date of Birth
Preferred Location
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InSight Parker
InSight Denver - Lowry
InSight Denver - Yale
InSight Boulder
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)
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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?
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?
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Yes
No
Submit