Orange County, California
800-974-EYES (3937)

LASIK Self Candidacy Test

Harvard Eye Associates is so much more than a LASIK clinic. Certainly, LASIK is the most popular form of vision correction, but we also offer an array of excellent options that might be better for some patients. Please take a moment to complete the form below so that we may better understand your vision and lifestyle aspirations. After completing the form, our vision correction coordinator will contact you to discuss the first step toward a possible lifestyle without glasses or contacts!

  * Red denotes required information
First Name: *
Last Name: *
Phone: *
E-mail: *
  1. Do you have trouble seeing far away or up close?

    Up close
    Far away
    Both, distance and reading vision

  2. Do you play sports or have other activities where it would be beneficial to NOT have to wear glasses?

    It's very important to me to NOT wear glasses for sports or other activities.
    It's somewhat important to me. They interfere in some activities.
    It's not important to me. I do not mind wearing glasses.

  3. What is your age?

    Under 21
    21 - 40
    41 - 55
    Over 55

  4. If you're over the age of 40, how important is it to you to be able to READ without glasses? Are you OK wearing reading glasses as long as you see well in the distance?

    It's very important to me to NOT wear reading glasses.
    It is somewhat important to me.
    It's not important to me. I do not mind wearing reading glasses to see things up close.

  5. What do you currently wear? Check all that apply.

    Contact lenses
    Reading Glasses

  6. How strong is your current prescription?


  7. Has your prescription been changing significantly every year, enough that you can't wait to get to the eye doctor because you can't see well enough?


  8. Have you ever had previous eye surgery?


E-mail and web page inquiries are usually reviewed within 1-2 business days. Urgent or private medical information should not be sent by e-mail or via our web page. If you have a medical emergency, please call 911 or your local emergency medical system by telephone. Information transmitted by e-mail or via our website may be viewed by others, and Harvard Eye Associates cannot guarantee the privacy of any information transmitted in this way.

For LASIK Risks and Side-Effects, Click Here.

back to top

Our Promise

As always, Harvard Eye is first and foremost concerned about what is best for each individual patient. Call us today for your personalized consultation!

Harvard Eye Associates
Laguna Hills Office

Map and Directions
24401 Calle de la Louisa
Suites 300-312
Laguna Hills, California 92653

FAX: 949-356-1660
Harvard Eye Associates
San Clemente Office

Map and Directions
665 Camino de los Mares
Suites 102-103
San Clemente, California 92673

FAX: 949-356-1660

The eye doctors of Harvard Eye Associates perform advanced technology diagnostic testing and treatment, as well as taking the time necessary to provide each patient with information needed to fully understand his or her condition and to achieve the best possible visual outcome.

If you or a family member or friend have not had a recent routine eye examination, have a specific eye condition that needs addressing, or are looking for an eye specialist, second opinion, or professional eye consultant please take a moment to Request an Appointment.

In The News

When exciting improvements in a current technique or product are introduced to the ophthalmic world, Harvard Eye Associates is often involved in the related clinical studies.

As a trusted, advanced clinical research study center, Harvard Eye Assoicates makes it possible to offer qualifying patients access to advancements in eye care not yet available to the general public.

Click below to see how you may benefit.

Clinical Research Study

Ask The Eye Doctor

If you have questions about your eyes, Harvard Eye Associates is here with the information you need.

We've dedicated sections of our website expressly to list of Frequently Asked Questions and Answers, covering cataract surgery, glaucoma, retina, LASIK, macular degeneration, dry eyes and more, plus an online form where you may submit questions directly to an eye doctor.

Please click below to have your questions about vision answered.

Learn More

Why Choose Us

Internationally regarded as the go-to specialist in eye care, Harvard Eye offers a combined experience of over 100 years and over 100,000 surgical procedures. The doctors of Harvard Eye Associates have treated virtually every known eye condition there is, plus a few previously unknown.

Learn More

Before Your Visit

Whether you or a loved one are having a first eye exam, a repeat eye exam, or are seeing a new eye doctor at Harvard Eye for the first time, there are a number of routine questions you can expect.

Your answers to these questions during eye exams are anything but routine for your eye doctor, so you may want to arrive prepared.

Learn More

Meet Our Patients

Read testimonials and watch videos of actual Harvard Eye Associates patients who have benefited from our professionalism, dedication, and commitment to high quality patient care.

Our offices provide patients with all eye care needs from routine eye exams to complex surgical procedures.

We are both proud and grateful that our patients have chosen to trust their vision with Harvard Eye!

Learn More

How We Give Back

Volunteer work is extremely important to Harvard Eye Associates. Twice yearly, we travel the world to teach and perform surgery to people who have no other resources, and have raised hundreds of thousands of dollars to providing medical training and supplies to developing countries.

Learn More