Please note that masks remain in full effect for this clinic until further notice.
Our clinic’s primary concern is for the well-being and continued protection of our vulnerable patient population and staff. We greatly appreciate your ongoing cooperation.

Vision Correction Lifestyle Questionnaire

Your eyes are very important and we would like to know how you use your eyes on a daily basis. Along with your eye exam, this information will assist us to recommend the best options for your personal visual goals.

  • Do you wear glasses now?*
  • Do you have a particular motivation for wanting laser vision correction?*
  • Do you drive at night?*

Any other regular activities not listed?*

What has prevented you from proceeding with laser vision correction before now?*

How soon do you want to have your surgery done?*

Please select an option to describe your personality as best you can:*

Canadian Ophthalmological Society
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