Freedom Eye Surgery – Laser Diagnostic Are you suitable for laser eye surgery? Take the test! 1. Patient Details: a) Name * First Last b) Phone * c) Email * 2. What is your age? * This field is required. 45 years or under Over 45 years 3. When do you wear glasses? * This field is required. All the time Just for reading Just for distance 4. Do you wear contact lenses? * This field is required. No Soft contacts Hard contacts 5. Do you have a history of Keratoconus? * This field is required. No Yes Don't know 6. Have you had previous eye surgery? * This field is required. No Yes - please describe.. 7. We would like to understand more about your needs. a) What are your visual requirements for work? b) What sporting or leisure activities do you enjoy? 8. Wish list: What experiences would be enriched with your new vision?