Falls Church, VA
703-912-0504
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Our Team
Anh Nguyen, MD
David L. Parver, MD
Randall Wong, MD
Roshni Patel, OD
Layla Kominiak
Patient Ambassadors
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Glaucoma
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Cataract Self-Test
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Cornea Surgery
Corneal Transplant
DMEK
Cross Linking
Retina Surgery
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Request an Appointment
First Name
*
Last Name
*
Phone
*
Email
*
Procedure of Interest
*
Procedure of Interest
Cataract Surgery
Chalazion
Dry Eye
Flashes and Floaters
Glaucoma
Keratoconus
Lens Implants
Macular Degeneration
Pterygium
Refraction
Cataract Surgery
Cornea Surgery
Cosmetic Procedures
Laser Vision Correction
Retina
Message
*Hours may vary. Please contact us for questions about scheduling
Request an Appointment
LASIK Self-Test
Home
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Procedures
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Laser Vision Correction
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LASIK Self-Test
LASIK Self-Test
First Name:
*
Last Name:
*
Email Address:
*
Phone
1 - Do you have trouble seeing far away or up close?
Select
Up Close
Far Away
2 - How interested are you in being able to play sports without glasses and contacts?
Select
It's very important to me NOT to wear glasses for activities such as sports.
It's not important to me. I do not mind wearing glasses.
3 - What is your age?
Select
Under 21
21 - 39
40 - 55
56-69
70+
4 - Are you interested in seeing well up close (reading) without glasses?
Select
It's very important to me NOT to wear reading glasses.
It's not important to me. I do not mind wearing reading glasses to see things up close.
5 - Do you wear contact lenses or glasses?
Select
Glasses
Contact lenses
6 - Would your career or business activities improve if you were to become less dependent on glasses and contacts?
Select
Yes
No
Maybe
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?
Select
Yes
No
8 - If you are a candidate, when would you like to get surgery?
Select
Less than a month
1-3 months
3-6 months
More than 6 months
*Hours may vary. Please contact us for questions about scheduling
Request your appointment
First Name
*
Last Name
*
Phone
*
Email
*
Procedure of Interest
*
Procedure of Interest
Cataract Surgery
Chalazion
Dry Eye
Flashes and Floaters
Glaucoma
Keratoconus
Lens Implants
Macular Degeneration
Pterygium
Refraction
Cataract Surgery
Cornea Surgery
Cosmetic Procedures
Laser Vision Correction
Retina
Message
*Hours may vary. Please contact us for questions about scheduling
Home
Our Team
▼
Anh Nguyen, MD
David L. Parver, MD
Randall Wong, MD
Roshni Patel, OD
Layla Kominiak
Patient Ambassadors
Conditions
▼
Cataracts
Refraction
Keratoconus
Dry Eye
Glaucoma
Pterygium
Chalazion
Flashes and Floaters
Macular Degeneration
Procedures
▼
Laser Vision Correction
▼
LASIK Eye Surgery
LASIK Self-Test
PRK
Cataract Surgery
▼
Laser Cataract Surgery
Cataract Self-Test
Lens Implants
Cornea Surgery
▼
Corneal Transplant
DMEK
Cross Linking
Retina Surgery
Implantable Collamer Lens (ICL)
Contact Lenses
▼
Order Contacts Online
Cosmetic Procedures
▼
Botox
Dysport
Restylane
Radiesse
Belotero
Peels
Resources
▼
Blog
Patient Testimonials
Patient Forms
Patient Financing
In The News
Contact
