h
h

Do your glasses or contacts prevent you from enjoying every day living? Yes   No
Do you feel very dependent upon your glasses or contacts? Yes   No
Are you scared of the thought misplacing your glasses or contacts? Yes   No
Does putting on and taking care of contact lenses seem like a hassle? Yes   No
Are you happy with your appearance with glasses? Yes   No
Do your glasses or contacts interfere with your recreational activities? Yes   No
Do you consider yourself intolerant to contact lens wear? Yes   No
Would you only have LASIK if you could be assured of never needing glasses or contacts again? Yes   No
Do your hobbies or occupation require "perfect vision"? Yes   No
If you are a contact lens wearer, can you wear them comfortably each and every day for as long as you would like? Yes   No
If you are a contact lens wearer, do your lenses get dry and/or gritty during the day?

Yes   No
Name:*
Email:*   
Phone:*  
    
©2009 Dr. Kenia All Rights Reserved home | sitemap | contact us Powered By: Zeugma