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Surgery Suitability Self Test

Get Started on Your Journey to Better Vision

To provide you with a tailored assessment for surgery suitability, please fill out the form below. Your answers will help us understand your vision needs and concerns.

Title

First Name

Last Name

Phone

Email

Please select the option that represents your age group:

Do you experience any of the following vision issues? (Select all that apply)

Farsightedness (difficulty seeing things up close) Nearsightedness (difficulty seeing things far away) Astigmatism (distorted vision) None of the above

Do you use glasses or contact lenses for:

Driving Computer work Reading None of the above

Have you undergone any of the following eye procedures? (Select all that apply)

LASIK SMILE LASEK PRK Cataract Surgery Lens Replacement Surgery None of the above

Check any of the following conditions that you have been diagnosed with:

Multiple Sclerosis Lupus Dry Eyes Keratoconus Diabetic Retinopathy None of the above

How would you describe your overall eye health?

Are you currently experiencing any eye pain or discomfort?

Have you noticed any recent changes in your vision?

If yes, please describe:

What would be your ideal outcome?

Freedom from glasses or contacts Removal of your cataract and glasses for reading Removal of your cataract and freedom from glasses Removal of your conjunctival naevus White eyes None of the above - Please specify below

Please specify your ideal outcome:

GDPR Agreement

By submitting this form, I agree to be contacted by Blue Fin Vision for a follow-up on my self-assessment.

Our Surgery Locations

The Harley Street Eye Centre
22A Harley Street, London, W1G 9BP
Weymouth Street Hospital
42-46 Weymouth Street, London, W1G 6NP
Phoenix Hospital Chelmsford
Essex Healthcare Park, West Hanningfield Road, Chelmsford, CM2 8HN
One Hatfield Hospital
3 Hatfield Avenue, Hatfield, Hertfordshire, AL10 9UA
London Eye Diagnostic Centre
25 Harley Street, London, W1G 9QW

Our Services

Cataract Surgery
YAG Laser Capsulotomy
Laser Eye Surgery
Lens Replacement Surgery
ICL Surgery
Conjunctival Naevus Removal
Glaucoma
Medical Retina
General Ophthalmology

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Get in Touch

enquiries@bluefinvision.com
07704 225640
Mon to Fri: 10am to 6pm
Surgery Suitability Self Test
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