303-794-1111
Provider Portal
LASIK Survey
Appointments
Insight Surgery Center
Call Us
Contact
Insight Surgery
Home
Services
Cataracts
LASIK and PRK
ICL
Glaucoma
Corneal Cross Linking
Cornea
Floater Removal
Presbyopia
Clear Lens Exchange
Advanced Dry Eye
Patient Information
Request an Appointment
New Patient Forms
Insurance
Patient Financing
Our Doctors
Team
Dr. Alan Barber
Dr. Michael Bollenbacher
Dr. Teresa Carlson
Dr. Thomas Cruse
Dr. C. Starck Johnson
Dr. Crystal Kasper
Dr. Ketty Lee
Dr. Chandni Merchant
Dr. Marc Otto
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
Contact Us
Office Locations
Careers
Referring Providers
Provider Portal
Events
Provider Forms
Sitemap
Home
About
Mission Statement
Locations
Services
Cataracts
LASIK and PRK
ICL
Glaucoma
Corneal Cross Linking
Cornea
Floater Removal
Presbyopia
Clear Lens Exchange
Advanced Dry Eye
Patient Information
Request an Appointment
New Patient Forms
Insurance
Patient Financing
Our Doctors
Team
Dr. Alan Barber
Dr. Michael Bollenbacher
Dr. Teresa Carlson
Dr. Thomas Cruse
Dr. C. Starck Johnson
Dr. Crystal Kasper
Dr. Ketty Lee
Dr. Chandni Merchant
Dr. Marc Otto
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
Contact Us
Office Locations
Careers
Referring Providers
Provider Portal
Events
POSTPONED due to COVID19 - InSight Vision Group's 19th Annual Spring Vision Congress. We will inform you of the new date when it is determined.
Provider Forms
Resource Library
do not delete
Insight Surgery Center
Testimonials
Extra
Thank You
Referral Registration
Referral Thank You
Welcome
Finalize Order
Finish Registration
Referral Login
Forgot Password
testing
Event Invite Registration
Event Invite Decline
Schedule an Appointment
×
Preferred Date
*
Are you a current patient?
*
Yes
No
First Name
*
Last Name
*
Phone Number
*
Email Address
*
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)
*
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?
Which location would you prefer?
*
LASIK Parker Office
LASIK Boulder Office
What Age Group Are You In?
*
18 years old and younger
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