Main Office

Dr. Black's Eye Associates of Southern Indiana
302 W. 14th Street, Suite 100A
Jeffersonville, IN 47130
Phone: (812) 284-0660
Monday—Friday | 8 a.m.– 5 p.m.

Vision Surgical Center

Dr. Black's Eye Associates of Southern Indiana
302 West 14th Street, Suite 100B
Jeffersonville, IN 47130
Phone: (812) 284-1700
Monday—Friday | 8 a.m.– 5 p.m.

  • increase text size:
  • A
  • A
  • A

LASIK Quiz

The only way to know if you’re a true candidate for LASIK is to have a thorough professional evaluation. Use this self-evaluation to get a clearer idea of whether LASIK is right for you. Fill in your contact information, answer every question and hit submit, and one of our LASIK counselors will contact you within one business day.

Do you wear glasses or contacts?




If you wear contacts, check all that apply:




Are you in good general health?


Have you ever had eye surgery?


Have you ever had any eye injuries or diseases?


Have you ever been diagnosed with cataracts?


Which of the following conditions do you have (select all that apply)?



How well do you see at night?



Do you use reading glasses or bifocals?


Which is the most important issue for you regarding LASIK?




Do you know what is involved in a LASIK procedure?



Are you concerned that the risks outweigh the benefits of LASIK?



Have you ever had a LASIK evaluation before?


Terms of Use*
By checking the box on the contact form, you agree to the Terms of Use listed here: Communications through our website or via email are not encrypted and are not necessarily secure. Use of the internet or email is for your convenience only, and by using them, you assume the risk of unauthorized use. By checking this box you hereby agree to hold Dr. Black's Eye Associates of Southern Indiana, its doctors and affiliates, harmless from any hacking or any other unauthorized use of your personal information by outside parties.



Back to Top