Social Accounts Sprite

Take this Lasik questionnaire to find out.


This is a series of questions you will be asked by our staff when evaluating your qualifications for Lasik. If you answered NO to most of the questions, please call us at (414) 955-7902. View this questionnaire as a PDF document.

Yes  No


Yes  No

Yes  No

Is your prescription for glasses outside Dr. Koenig's treatment range?

Ideal candidates are Nearsighted -1 to -10 Diopters with no more than 4 Diopters of Astigmatism.


Yes  No

Do you wear contacts?

If yes, prior to exam/surgery, contacts must be left out a minimum of 2 weeks for soft lenses (full 14 days without wearing contacts) OR a minimum of 3 weeks for toric, hard or gas permeable lenses (add 1 week if worn 20 years or longer).


Yes  No Are you under the age of 21? (Patient must be at least 21 to schedule an evaluation.)

Yes  No Have you ever been diagnosed with any condition that affects your body's ability to heal, such as diabetes, a collagen vascular disease (such as rheumatoid arthritis), an autoimmune disease (such as lupus), an immunodeficiency disease (such as HIV or AIDS)? If yes, Dr. Koenig does not recommend Lasik surgery.

Yes  No Have you ever been told by your eye doctor that you show signs of Keratoconus or been diagnosed with any eye condition, such as dry eye, glaucoma or cataracts?

Yes  No Have you previously undergone eye surgery? If yes, please let us know.

Yes  No Women: Are you pregnant or nursing?

Yes  No Have you taken the medication Isotretinoin, brand name Accutane, within the past 6 months?

Yes  No Do you take any prescription migraine medications? (for example: IMITREX)

Yes  No Are you currently taking the medication Amiodarone Hydrochloride, brand names Cordarone or Pacerone?

If you answered NO to most of the questions, please call us at (414) 955-7902.

Contact Us

Dr. Koenig is extremely pleasant, good natured, and has a wonderful beside manner. He was available and willing to answer any questions I had and even rang me back.

Jacqueline M.

X CLOSE

The Eye Institute

925 N 87th St
Milwaukee, WI 53226

Open Today 8:00am - 5:00pm

X CLOSE

Contact Us