Hartzell EyeMDs - Carlisle, PA 37 Brookwood Ave.
Carlisle, PA 17013
Tel: 717-243-8606

 
Refractive
Laser Surgery		Cataract SurgeryGlaucoma
Management		Plastic SurgeryDiabetic Care &
Laser Therapy

Hartzell EyeMD's
Ophthalmologists

    PATIENT EXPECTATION PROFILE

      Below is a personal profile to help determine if laser vision correction is for your. Answer the following statements that apply to you in the Y column::

         N    Y
        I am a flexible, easy-going person.
        I adjust to change rather easily.
        I have never been able to wear contact lenses successfully.
        I would be satisfied if my natural vision were greatly improved, even if I still had to wear corrective lenses some of the time.
        I am not a perfectionist.
        I often wish that I did not have to wear corrective lenses.
        I feel my appearance is better without glasses.
        I feel new career opportunities would be open to me if I did not have to wear glasses or contacts.
        I feel good vision without glasses or contacts is more important than having great vision with them.
        I find my participation in Sports and other activities is restricted by wearing corrective lenses.
        I fear I would be totally disabled if I lost my contacts or broke my glasses.
        I am certain that there are no restrictions regarding my position with my employer that pertain to laser vision correction. (If you are uncertain, please ask -- it is your responsibility.)

        Enter the number of "Y" Checks above.


    Ten or More:
      If you checked ten or more, you have realistic expectations about the results of laser vision correction and are ready to take the next step and schedule a medical eye examination.

    Five to Nine:
      If you checked five to nine, contact your doctor for more information on what you can expect with laser vision correction.

    Zero to Four:
      If you checked zero to four, please discuss the results of this profile with your doctor.


    This form is strictly for your own use; no information will be transferred to our office. We suggest that you print a copy showing your answers, and bring it with you when you come to discuss laser vision correction with our doctors.


    Call Hartzell Eye Doctors at: (717) 243-8606 for an appointment with one of our ophthalmologists.