Preliminary Qualification Form

He will fill it out and send it. After we receive it and the doctors analyze the data, we will reply to the e-mail address you provided in the questionnaire whether laser vision correction is the solution for you.

Current step:1Dane osobowe
2Wada wzroku i stosowana korekcja
3Stan zdrowia i zażywane leki
4Ciąża i karmienie piersią (pytania skierowane do kobiet)
5Wybór rodzaju procedury i dodatkowe informacje

Step 1: Personal information

Age*
Preferred form of contact:

Make sure that the phone number provided is correct.

Step 2: Vision defect and current correction method

The degree of your vision defect and its stability are among the many criteria considered during the qualification process for laser vision correction.

1. My vision defect is: *
2. I use eyeglass correction (on a daily basis):
3. I use glasses only for reading

Presbyopia is a natural, progressive, physiological process of the body. The effect of presbyopia can be eliminated by laser, but only in people who have a visual defect that is corrected with glasses or contact lenses.

4. I use extra glasses only for reading

Presbyopia is a natural, progressive, physiological process of the body. The effect of presbyopia can be eliminated by laser, but only in people who have a visual defect that is corrected with glasses or contact lenses.

5. I have progressive glasses

Presbyopia is a natural, progressive, physiological process of the body. The effect of presbyopia can be eliminated by laser, but only in people who have a visual defect that is corrected with glasses or contact lenses.

6. I use contact lenses:

You should stop using soft contact lenses a minimum of 7 days before the daily procedure. For hard or toric (cylindrical - correcting astigmatism) lenses, the time is a minimum of 3-4 weeks.

7. With glasses or contact lenses, I can see sharply
8. My vision has worsened in the last 12 months

Step 3: Health status and medications taken

Uncontrolled chronic diseases and some of the medications taken may be a contraindication to laser vision correction surgery.

1. Ophthalmologic procedures were performed on me
2 I have been diagnosed with eye diseases or degeneration (including glaucoma, cataracts, macular degeneration, retinal degeneration, corneal cone)
3. I have a chronic illness
4. I use prescription drugs
5. I have a pacemaker implanted
6. In the past 3 months, I have undergone procedures involving tissue disruption (including surgical operations, dental procedures, aesthetic medicine treatments, or tattooing).

Step 4: Pregnancy and breastfeeding (questions for women)

Hormonal changes occurring in the body, often referred to as a “hormonal storm,” can cause fluctuations in vision. In such cases, the qualification examination may be unreliable, and the effects of the procedure may only be temporary.

1. I am pregnant
2. I am currently breastfeeding
3. I am planning a pregnancy within the next 6 months

Step 5: Selecting the type of procedure and additional information

Let us know what type of procedure you are interested in. If you have additional questions or want to share additional information with us post it here.

1. I am interested in:
2. What time period are you interested in?