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How did you hear about us?
Name(Required)
Date of Birth(Required)
Gender(Required)
Are you currently pregnant or breastfeeding?
Address
Max. file size: 50 MB.
Because we are a medical office, you will need to bring a copy of your ID with you to your first visit. We will make a copy of it when you arrive, but if you would like to scan or take a picture and upload it here yourself, it will save time at your visit. If you have any questions or concerns regarding this, please don’t hesitate to call us.
Medical History
Do you have any of the following conditions?
Please list any other medical conditions that you have.
Please list any medications you are currently taking.
Have you ever had LASIK before?
Eye History
Have you ever had any eye injuries, eye surgeries, or been diagnosed with any eye conditions or diseases (other than needing glasses and contacts)?
Please describe your previous eye injuries, eye surgeries and/or eye conditions.
Have you ever had a consultation for LASIK or vision correction before?
Ocular prosthetic devices
Which of the following do you wear?
For my glasses, I wear…
My contacts are…
Contact Lens Cessation
Wearing contact lenses can warp the shape of your eye. In order to get accurate scans and measurements of your eye for you Advance Ocular Analysis, we request that you be out of soft contact lenses for at least a week prior to your visit. If this is not possible or you have any concerns about it, please call or text us at 971-362-2020.
Contact Lens Cessation
Wearing contact lenses can warp the shape of your eye, and hard contact lenses have a much greater effect than soft contact lenses. We ask that you be out of your hard contact lenses for at least a week prior to your AOA. However, please be aware that to get the most accurate measurements it is often recommended to be out of hard contact lenses one month for every decade that you have been wearing them. If this is not possible or you have any concerns about it, please call or text us at 971-362-2020.
If you know it, please enter your glasses prescription
If you know it, please enter your glasses prescription
If you have it, please upload a photo of your contact lens box or blister pack that shows your prescription.
Max. file size: 50 MB.