Please fill out the form below as completely as possible to determine whether lasik surgery is the best option for you. You may also contact us at the address below.

Kraff Eye Institute
25 East Washington, Suite 606, Chicago, IL 60602
Tel: 312-338-1234 E-mail: info@kraffeye.com
Web: http://www.kraffeye.com

Which of the following vision problems do you have? Choose One: Nearsighted (cannot see distances) Farsightedness (cannot see close up) Astigmatism None of the Above Do Not Know When do you currently use glasses or contact lenses? Choose One: For Reading Only For Distance Only All of the Time None of the Time What eye problems have you ever experienced? Choose One: Cataracts Glaucoma Corneal Disease Eye Injury Iritis Retinal Disease More than One of the Above None of the Above Do Not Know Have you ever had any type of refractive eye surgery? Choose One: Yes, PRK Yes, RK Yes, Lasik Yes, AK No How old are you? Choose One: Under 18 Years Old 18-21 Years Old 22-39 Years Old 40-64 Years Old Over 64 Years Old

Lasik surgery will change the way you see the world!