Lasik Enquiry Form

Lasik Laser Eye Surgery

Most people can enjoy the benefits offered by modern eye surgery. But for some people surgery may not be the best option.

Let Us Assess your Suitability

If you have your Prescription from your optician we can quickly assess your suitability.

Enter your prescription:

Please complete as much of the form as you can. We will respond within 48 hours with our assessment of your suitability.

Sph

Cyl

Axis

Prism

Base

Sph

Cyl

Axis

Prism

Base

Right

Distance

Left

Near

Any other information on your prescription:

Please enter your contact details:

Name: *

Email Address: *

Date of Birth:

[ Date of birth required to determine suitability ]

Telephone Number:

Address:

Our Response

We will respond within 48 hours with our evaluation. If laser eye surgery is suitable for you, we will invite you to discuss your options in detail in a free consultation with one of our Consultant Ophthalmologists.

Lasik Enquiry Form

Lasik Laser Eye Surgery

Let Us Assess your Suitability

Enter your prescription:

Please enter your contact details:

Our Response

Contact

I wish to thank the entire team for the care and attention. Thank you.

Mary B (Sep 2006)

Ophthalmic Surgeon:
Mr Sajjid Haider
Procedure: Cataract surgery

Lasik Enquiry Form

Lasik Laser Eye Surgery

Let Us Assess your Suitability

Enter your prescription:

Please enter your contact details:

Our Response

Contact

I wish to thank the entire team for the care and attention. Thank you.

Mary B (Sep 2006)

Ophthalmic Surgeon: Mr Sajjid Haider Procedure: Cataract surgery

Ophthalmic Surgeon:
Mr Sajjid Haider
Procedure: Cataract surgery