For Total Precision call toll free: 877.764.1504  |  1810 30th St. Suite B, Boulder CO. 80301

Self-Evaluation test

  1. Do you have trouble seeing far away or up close?
  2. How interested are you in being able to play sports without glasses and contacts?
  3. What is your age?
  4. Are you interested in seeing well up close (reading) without glasses?
  5. Do you wear contact lenses or glasses?
  6. Would your career or business activities improve if you were to become less dependent on glasses and contacts?
  7. Over 98% of LASIK patients see 20/40 or better after surgery. The results of LASIK laser vision correction have been tremendous for literally millions of people. Despite the amazing safety and results of this procedure there are associated risks. Are you willing to discuss these risks with our LASIK coordinator?

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If you are interested in more information regarding our advanced vision correction procedures please feel free to fill out the form below.

First Name:

Last Name:

Street Address:

ZIP Code:

Email Address:

Phone Number:
( ) -


Do you wear:
glasses
contacts
neither

bifocials
reading glasses


Describe your vision problem.
Have you had any major fluctuations in your vision in the past year?
Yes
No


Could getting rid of glasses make a major impact on your lifestyle.
Yes
No


Are you over the age of 21 years old?
Yes
No


Questions or comments? Please let us know and we’ll respond back to you as soon as possible.


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