Please enable JavaScript in your browser to complete this form. – Step 1 of 4What Is Your Age Group? *Under 1819 – 3940 – 4950+Without My Glasses Or Contacts… *I have trouble reading and seeing things up close.I have trouble driving and seeing things far away.check all that applyWhat Do You Usually Wear? *Progressives/BifocalsDistance GlassesReading GlassesContactsNonecheck all that applyNextDo You Have Any Of The Following? *AstigmatismRheumatoid ArthritisLupusKeratoconusPrevious Eye SurgeryCurrently PregnantMultiple SclerosisCataractsDiabetic RetinopathyPrior Major Eye InjuryProsthetic/Fake EyeNone Of The AboveHow important is it for you to enjoy outdoor activities and/or sports without glasses and contacts? *It’s very important to me NOT to wear any glasses.I do not mind wearing glasses for distance.I do not mind wearing glasses for reading.Would your career or business activities improve if you were to become less dependent on glasses and contacts? *YesNoMaybeNextHow Much You Could Save With LASIK A 2019 study performed by the Canadian Association of Optometrists showed that, on average, Canadians spend $350/year on their prescription lenses. By getting laser vision correction now, someone in their mid 30’s could save approximately $7,000 while someone in their mid 20’s could save over $10,500 throughout their life! Don’t wait, start saving now by getting laser vision correction with BCLasik! Do You Want To Save Money By Getting Laser Vision Correction?Yes, I want to save money!No, I like paying for my prescription lenses.NextLooks like you could be a great candidate for LASIK or one of our other refractive procedures! Fill out the information below and look out for an email to learn more about our vision correction procedures. Name *FirstLastEmail *Phone Number *Preferred Clinic Location *SurreyAbbotsfordWould you like to learn about your vision correction options with one of our refractive counselors? *YesNoSubmit
