Are You A Candidate For LASIK Eye Surgery?

Take this short quiz to find out if you can be on the path to better vision.

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First Name

Phone Number

What is your Age?

Are you interested in seeing well up close (ex. reading) without glasses?

Do you know your visual prescription?

Do you have dry eyes?

Do you have trouble seeing far away or up close?

What is your current method of vision correction?

Has your prescription been stable over the past two years?

Consent you Has

Do you have any autoimmune diseases, collagen vascular diseases, diabetes, or are immunocompromised??

Do you have corneal thinning (keratoconus), corneal scarring, glaucoma, cataracts, herpetic eye disease, or retinal disease?

A surgical consultant from Little Rock Eye Clinic will contact you with your results. Would you prefer we reach you by phone or email?

How did you First hear about us?

Consent to Submit Information

I agree to the below statement.

By checking this box, I acknowledge that I am voluntarily submitting personal health information, including details about my eyes, and I consent to its collection and secure transmission. I understand that this form is intended for informational purposes only and does not establish a provider-patient relationship.

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Little Rock Eye Clinc

With a legacy spanning over five decades, Little Rock Eye Clinic has been the cornerstone of eye health in Central Arkansas, offering comprehensive services from routine eye care to complex disease treatment. Originating from the Cosgrove and Henry Clinic and evolving through various expansions and specializations, our clinic now boasts three locations, a team of board-certified eye care specialists, and a full optical department, making us a one-stop solution for all your eye care needs.

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Are You A Candidate For LASIK Eye Surgery?

Take this short quiz to find out if you can be on the path to better vision.

Contact Info

Our Expertise

Patient Education

Cataracts

Retina