Questionnaires

Questionnaires

Questionnaires

Questionnaires

Questionnaires

Questionnaires

Questionnaires

Questionnaires

Questionnaires

RALEIGH EYE CENTER’S LASIK QUESTIONNAIRES

At Raleigh Eye Center, we’ve seen refractive surgeries such as LASIK and PRK change our patient’s lives. If you’re tired of glasses and contacts, consider receiving refractive surgery from our professional Raleigh ophthalmologists. Not sure if LASIK will work for you? Answer the following questionnaire. We would also love for you to share your refractive surgery experience through our post-procedure questionnaire.

AM I A CANDIDATE FOR LASIK?

The most reliable way to know if you are a true candidate for LASIK is to have a thorough evaluation provided by a professional. Use this self-evaluation to get a better idea of whether refractive surgery is right for you, and contact us to schedule an evaluation with one of our Raleigh ophthalmologists.

Your Name*
Your E-mail*
Phone*
Are you in overall good health?
Do you wear reading glasses or bifocals? *
Have you previously had a LASIK consultation?*
What is most important to you regarding LASIK


LASIK/PRK POST-PROCEDURE QUESTIONNAIRE

Did you receive a refractive surgery at Raleigh Eye Center? If so, we would appreciate hearing your thoughts on your LASIK or PRK experience. Please take a few minutes to answer the following questions in our post-procedure questionnaire.

Email
What struggles did you have with glasses/contact before having LASIK or PRK?
What was the day of your procedure like?
How would you describe your vision after the procedure?
How has your life improved since your procedure?
Can we use your survey for a testimonial to share with others? If so, you will be entered into our monthly drawing for a $100 VISA gift card.


​​​​​​​Raleigh Eye Center provides exceptional eye care and corrective eye surgeries in Raleigh, NC and surrounding areas, including Cary, Apex, Wake Forest, Chapel Hill, Durham, Garner, Fuquay-Varina and beyond.

Pajibar00 none 9:00 AM - 5:00 PM 9:00 AM - 5:00 PM 9:00 AM - 5:00 PM 9:00 AM - 5:00 PM 9:00 AM - 5:00 PM Closed Closed optometrist https://www.google.com/search?q=raleigh%20eye%20centers%20NC&oq=raleigh+eye+centers+NC&aqs=chrome..69i57j0i22i30l2.2105j0j7&sourceid=chrome&ie=UTF-8&tbs=lf:1,lf_ui:2&tbm=lcl&rflfq=1&num=10&rldimm=10187356156116757385&lqi=ChZyYWxlaWdoIGV5ZSBjZW50ZXJzIE5DSIeQoJ_rgICACFosEAEQAhADGAAYARgCGAMiFnJhbGVpZ2ggZXllIGNlbnRlcnMgbmMqBAgDEAGSAQ9leWVfY2FyZV9jZW50ZXKaASNDaFpEU1VoTk1HOW5TMFZKUTBGblNVTnBha3RMWVZaM0VBRaoBExABKg8iC2V5ZSBjZW50ZXJzKAA&ved=2ahUKEwjooMr3yKr1AhUPfN4KHah-DYcQvS56BAgDEEY&rlst=f#lrd=0x89ac58dc2d4660b7:0x8d60c272f5ba6b89,3,,,&rlfi=hd:;si:10187356156116757385,l,ChZyYWxlaWdoIGV5ZSBjZW50ZXJzIE5DSIeQoJ_rgICACFosEAEQAhADGAAYARgCGAMiFnJhbGVpZ2ggZXllIGNlbnRlcnMgbmMqBAgDEAGSAQ9leWVfY2FyZV9jZW50ZXKaASNDaFpEU1VoTk1HOW5TMFZKUTBGblNVTnBha3RMWVZaM0VBRaoBExABKg8iC2V5ZSBjZW50ZXJzKAA;mv:[[35.9119911,-78.5573754],[35.770828,-78.8027568]];tbs:lrf:!1m4!1u45!2m2!46m1!1e1!1m4!1u3!2m2!3m1!1e1!1m4!1u2!2m2!2m1!1e1!2m1!1e2!2m1!1e3!3sIAE,lf:1,lf_ui:2 https://www.facebook.com/raleigheyecenter/reviews/?ref=page_internal 3320 Executive Drive #111
Raleigh, NC 27609 https://g.page/raleigh-eye-center?share 9198762427 8005960384 9198509234 Monday-Thursday: 8 a.m. – 5 p.m.
Friday: 8 a.m – 1 p.m. Monday-Thursday: 8:30 a.m. – 6 p.m.
Friday: 8 a.m – 1 p.m. 2406 Blue Ridge Road, Suite 280
Raleigh, NC 27607 https://g.page/raleigh-eye-center-blue-ridge?share 9198762427 Monday-Thursday: 8 a.m. – 5 p.m.
Friday: 8 a.m. – 1 p.m. 6104 Fayetteville Road, Suite 108
Durham, NC 27713 https://g.page/raleigh-eye-center-durham?share 9198762427 8005960384 4345849895 Monday-Friday: By Appointment Only 870 N. Mecklenburg Avenue
South Hill, VA 23970 https://goo.gl/maps/EErKZBPmKAzYi2zE8 9198762427 8005960384 9195729200 Monday-Thursday: 8 a.m. – 5 p.m.
Friday: 8 a.m. – 1 p.m. 730 S. Scales Street
Reidsville, NC 27320 https://goo.gl/maps/tqeCtadaRvNzLCD9A 9198762427 8005960384 9192298039 Monday-Friday: By Appointment Only