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Find out if you are a candidate

Are you considering LASIK or cataract surgery? Complete this survey to find out if you're a candidate:

Choose Eye Health Survey *LasikCataract

Cataract Surgery Candidacy Survey

Please fill out the form below to get started

First Name *

Last Name

Phone *

Email Address *

LASIK Surgery Candidacy Survey

Please fill out the form below to get started

First Name *

Last Name

Phone *

Email Address *

Cataract Surgery Candidacy Survey

What is Your Age Range?

Under 1819 - 3940 - 5960+

LASIK Surgery Candidacy Survey

What is Your Age Range?

Under 1819 - 3940 - 5960+

Cataract Surgery Candidacy Survey

Without My Glasses or Contacts

FarsightednessNearsightednessAstigmatism

LASIK Surgery Candidacy Survey

Without My Glasses or Contacts

FarsightednessNearsightednessAstigmatism

Cataract Surgery Candidacy Survey

What Do You Usually Wear?

GlassesContactsReading GlassesNone

LASIK Surgery Candidacy Survey

What Do You Usually Wear?

GlassesContactsReading GlassesNone

Cataract Surgery Candidacy Survey

Do You Have Any of the Following Health Conditions?

Rheumatoid ArthritisMultiple SclerosisLupusCataractsKeratoconusDiabetic RetionopathyPrior Eye SurgeryPrior Eye InjuryPregnant or NursingNone

LASIK Surgery Candidacy Survey

Do You Have Any of the Following Health Conditions?

Rheumatoid ArthritisMultiple SclerosisLupusCataractsKeratoconusDiabetic RetionopathyPrior Eye SurgeryPrior Eye InjuryPregnant or NursingDry EyesNone

Cataract Surgery Candidacy Survey

Have You Been Told You Have Cataracts and Require Surgery?

YesNoNot Sure

LASIK Surgery Candidacy Survey

Rate This Statement on a Scale of 1 to 5 With 1 Being the Lowest.

I would like to see well at a distance without relying on glasses and contact lenses. *12345

Cataract Surgery Candidacy Survey

Are the Following Statements Important to You?

(Check all that apply.)

I would like to see well at a distance without relying on glasses and contact lenses. *YesNoNot Sure

I would like to see well up close without relying on glasses and contact lenses. *YesNoNot Sure

It is important to me to see well at night after cataract surgery. *YesNoNot Sure

Think about the things in life you want to do without depending on glasses after cataract surgery. Which group is the most important? *See Far AwaySee Medium DistanceSee Close UpSee Very Close

LASIK Surgery Candidacy Survey

Rate This Statement on a Scale of 1 to 5 With 1 Being the Lowest.

I would like to see well up close without relying on glasses and contact lenses. *12345

Cataract Surgery Candidacy Survey

Are You Ready to Schedule an Appointment?

YesI Want More InformationNo

LASIK Surgery Candidacy Survey

Would your lifestyle improve if you were to become less dependent on glasses and contact lenses? *YesNo

Are You Ready to Schedule and Appointment? *YesI Would Like More InformationNo

Please do not fill in this field.

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Keratoconus

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Keratoconus
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Jasmeet Dhaliwal
Caryn LaBuda

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Conditions +

Keratoconus

Conditions +

Keratoconus

Our Medical Team

Meet our Trusted Eye Care Specialists

Meet the most trusted team of eye care specialists, dedicated to delivering the best eye doctors in Chicago.

JASMEET DHALIWAL, M.D.

AMINA HUSAIN,M.D.

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Our Locations

Chicago

773-775-9755

773-775-4306

7447 W. Talcott Ave.
Suite 406
Chicago, IL 60631

Get Chicago Directions

Lombard

773-775-9755

630-724-1410

477 E. Butterfield Rd.
Suite 105
Lombard, IL 60148

Get Lombard Directions

Elgin

773-775-9755

224-238-3296

2371 Bowes Rd.
Suite 300
Elgin, IL 60123

Get Elgin Directions

7447 W. Talcott Ave., Suite 406, Chicago IL, 60631

773-775-9755

773-775-4306

Hours of operation

Monday – Friday: 7:30 AM – 3:30 PM

Locations

Chicago
Lombard
Elgin

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