| - |
Yes
|
No
|
| Has
your lens prescription changed significantly within the
last year? |
|
| Are
you pregnant? |
|
| Are
you nursing or expecting to become pregnant within six
months following the LASIK procedure? |
|
| Are
you afflicted with unstable or uncontrolled diabetes? |
|
| Do
you suffer from an autoimmune disease? |
|
| Do
you take drugs or undergo therapy that suppresses your
immune system? |
|
| Are
you afflicted with an uncontrolled vascular disease? |
|
| Do
you have medical problems related to your eyes, such as
Amblyopia, Keratoconus or Glaucoma? |
|
| Do
you have a history of excessive scarring with injuries
or other surgeries? |
|
| Do
you suffer from chronic herpes infections or connective
tissue disorders? |
|
| Do
you have Dry Eye Syndrome? |
|
| Do
you have myopia greater than -15D? |
|
| Do
you have hyperopia greater than +7D? |
|