Please enable JavaScript in your browser to complete this form. – Step 1 of 4 What Is Your Age Group? * Under 18 19 – 39 40 – 49 50+ 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 apply What Do You Usually Wear? * Progressives/Bifocals Distance Glasses Reading Glasses Contacts None check all that apply Next Do You Have Any Of The Following? * Astigmatism Rheumatoid Arthritis Lupus Keratoconus Previous Eye Surgery Currently Pregnant Multiple Sclerosis Cataracts Diabetic Retinopathy Prior Major Eye Injury Prosthetic/Fake Eye None Of The Above How 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? * Yes No Maybe Next How 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. Next Looks 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 * First Last Email * Phone Number * Preferred Clinic Location *SurreyAbbotsford Would you like to learn about your vision correction options with one of our refractive counselors? * Yes No Submit
