Lasik Hotline (617) 275-8820
Email Us
Book Appointment
About
Our LASIK Surgeons
Products & Procedures
LASIK Overview
PRK
EVO ICL
Refractive Lens Surgery
Wavelight Plus at Boston Vision
Contoura® Vision
FS200 Blade-Free LASIK Laser
Wavelight EX500 Excimer Laser
Videos
References
LASIK Self Test
How Does LASIK Work?
Why Not LASIK For $299?
LASIK Financing
LASIK Recovery
Ask The LASIK Expert
Blog
Testimonials
Read Reviews
How Did It Go
Locations
Andover
Brookline
Medford
Milford
Wellesley
Lawrence
Burlington
Contact
About
Our LASIK Surgeons
Products & Procedures
LASIK Overview
PRK
EVO ICL
Refractive Lens Surgery
Wavelight Plus at Boston Vision
Contoura® Vision
FS200 Blade-Free LASIK Laser
Wavelight EX500 Excimer Laser
Videos
References
LASIK Self Test
How Does LASIK Work?
Why Not LASIK For $299?
LASIK Financing
LASIK Recovery
Ask The LASIK Expert
Blog
Testimonials
Read Reviews
How Did It Go
Locations
Andover
Brookline
Medford
Milford
Wellesley
Lawrence
Burlington
Contact
Vision Correction Self-Test
Vision Correction Self-Test
LASIK, PRK, EVO-ICL, and Clear Lens Exchange
Step
1
of
9
11%
How did you hear about Boston Vision?
(Required)
Please Select One
Patient Referral
Staff Referral
Optometrist
Google
Redbook
Billboard
I am a current patient at Boston Vision
Facebook
Instagram
Vision Insurance
Radio (KISS 108)
Radio (98.5 The Sports Hub)
Have you had an evaluation before?
(Required)
Yes
No
What is the reason you have not moved forward with vision correction in the past?
(Required)
Fear of the procedure
Cost of the procedure
Timing
Other
Boston Vision offers interest-free financing, is this something you are interested in?
(Required)
Yes
No
Have you heard of the EVO ICL procedure?
(Required)
Yes, and I would be interested in this procedure
Yes, but I prefer not to have this procedure
No, but I would like to learn more
Have you heard of the Clear Lens Exchange procedure?
(Required)
Yes, and I would be interested in this procedure
Yes, but I prefer not to have this procedure
No, but I would like to learn more
Without your corrective lenses, do you have…
(Required)
Trouble seeing far away
Trouble seeing up close
Overall blurry vision
Trouble with reading only
Do you wear…
(Required)
Glasses
Glasses & Contacts
Contacts
Neither
Submit Your Personal Information
First Name
(Required)
Last Name
(Required)
Email Address
(Required)
Phone Number
(Required)
Confirm your age:
(Required)
Please Select One
Under 18
19-39
40-59
60+
Select location preference:
(Required)
Please Select One
Andover
Brookline
Medford
Milford
Wellesley
Lawrence
Burlington
This field is hidden when viewing the form
liine_guid_ph
