OD Professional Login 808-792-3937 1100 Ward Ave. Ste. 1000
Honolulu, Hawaii 96814

Contact Us: 808-792-3937

1100 Ward Ave. Ste. 1000
Honolulu, Hawaii 96814

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Vision Correction Questionnaire

If you are interested in LASIK, the Visian ICL™, Advanced Cataract Surgery or other vision correction options, please complete the self evaluation below and a member of our staff will contact you.

  1. (required)
  3. (valid email required)
  4. Do you have trouble seeing far away or up close?
  6. How interested are you in being able to play sports without glasses and contacts?
  8. What is your age?
  10. Are you interested in seeing well up close (reading) without glasses?
  12. Do you wear contact lenses or glasses?
  14. Would your career or business activities improve if you were to become less dependent on glasses and contacts?
  16. Have you had a LASIK evaluation?
  18. Have you been referred to a LASIK surgeon?
  20. I am interested in having the LASIK procedure:
  22. Captcha
 

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Driving Directions

Aloha Laser Vision is proud to serve patients traveling from nearby cities with expertise in quality eye care. We’ve provided directions to our practice from the following locations for your convenience: