Guest's Name	:		Arrival Date	:
Age	:		Departure Date	:
Gender	:	--- Male Female	Email	:

Thank you for choosing Sabah Medical Centre as your LASIK Centre! We hope your experience here will be a pleasant and rewarding one.

To avoid disappointment, the below check list is to help you as a general guideline. The suitability of LASIK can only be confirmed after undergoing the comprehensive LASIK eye examination in the centre here.

1. General medical concern
   LASIK not recommended for the conditions below:-
   
   Auto-immune diseases: (Rheumatoid Arthritis, SLE etc.)
   Diabetes
   Hepatitis
   Aids
   Psychiatric illness
   Depression
   Drug dependence (please refer to your doctor)
   Poor general health
   Pregnant or breast feeding (your spectacle power may be unstable)
   
2. Eye conditions:
   
   Have had stable vision for at least 1 year
   No current or previous serious eye diseases
   
3. Prescription:
   
   Glasses prescription
   

   Right eye:	Sph Cyl Axis
   Left eye:	Sph Cyl Axis

   Contact lenses prescription
   

   Right eye:
   Left eye: