---
title: LASIK Surgery Screening & Age Verification Form Template | Paperform
description: Pre-screen LASIK candidates with age verification, eye health history, prescription details, and consultation booking. Perfect for ophthalmology practices and laser eye surgery centers.
url: "https://paperform.co/templates/lasik-surgery-screening-age-verification-form"
type: static
generatedAt: "2026-03-28T00:44:21.059Z"
---

[← Back to free form templates](/templates/)    ![LASIK Surgery Screening & Age Verification Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/lasik-surgery-screening-age-verification-form.png)
    [Preview](https://_preview.paperform.co/ai-template/lasik-surgery-screening-age-verification-form) [Use this template for free](/create?ai-template=lasik-surgery-screening-age-verification-form)    [Verification & Validation Forms](/templates/category/verification/)[Healthcare & Medical Forms](/templates/category/healthcare/) [Healthcare](/templates/industry/healthcare/) [Physician](/templates/role/physician/)[Healthcare Administrator](/templates/role/healthcare-admin/)     About this free form template
### LASIK Surgery Screening & Age Verification Made Simple

LASIK eye surgery is a life-changing procedure, but not everyone is a suitable candidate. Before scheduling consultations or surgery, clinics need to verify patient age, collect detailed eye health history, understand current prescriptions, and assess overall eligibility—all while creating a smooth, professional experience that builds trust from the very first interaction.

This **LASIK Surgery Screening & Age Verification Form** is designed specifically for ophthalmology practices, laser eye surgery centers, and vision correction clinics. It combines age verification with comprehensive pre-screening questions, giving you the critical information needed to determine candidacy before patients even step through your door.

#### What makes this template essential for LASIK providers

Age is a fundamental eligibility criterion for LASIK—candidates must typically be at least 18 years old, with stable vision for 1-2 years. This form verifies age upfront while collecting eye health history, current prescription details, medications, previous eye surgeries, and lifestyle factors that affect candidacy. By gathering this information digitally, you can pre-qualify leads, identify potential red flags early, and ensure your consultation slots are filled with suitable candidates.

The form flows naturally from basic contact and age verification through vision history, eye health conditions, prescription stability, and lifestyle questions, concluding with a convenient consultation booking field. Conditional logic reveals relevant follow-up questions based on patient responses, keeping the experience personalized without overwhelming respondents.

#### Perfect for ophthalmologists, optometrists, and vision correction clinics

Whether you're a standalone LASIK center, part of a larger ophthalmology practice, or offering refractive surgery as part of comprehensive eye care, this template streamlines your patient intake process. It's ideal for practices that want to:

 - **Pre-screen candidates** before booking consultations to maximize appointment efficiency
 - **Verify age compliance** and capture signed acknowledgments
 - **Collect detailed medical history** including medications, conditions, and previous procedures
 - **Understand prescription stability** and vision correction goals
 - **Book consultations directly** without back-and-forth phone calls or emails

#### Seamless integration with your practice management tools

Built on Paperform, this template can be embedded on your website, shared via email campaigns, or promoted on social media to capture qualified leads. Submissions automatically sync with your CRM, practice management software, or scheduling tools through native integrations or via [Stepper](https://stepper.io) workflows.

You can route high-priority candidates to your surgical coordinator, flag potential complications for physician review, send automated confirmation emails with pre-consultation instructions, and trigger follow-up sequences—all without manual data entry. If you need signed consent forms after screening, [Papersign](https://papersign.com) lets you turn submissions into legally binding eSignature documents that patients can complete remotely.

#### Built for conversion and trust

First impressions matter in elective surgery. This form is designed to feel professional, reassuring, and easy to complete—not like a generic survey. The clean layout, logical question flow, and friendly tone help potential patients feel confident they're in expert hands, improving completion rates and reducing drop-off.

With Paperform's customizable themes, you can match your practice's branding perfectly, using your colors, fonts, and logo to create a cohesive experience from first click to consultation booking.

#### Compliant, secure, and scalable

Patient data deserves the highest level of protection. Paperform is **SOC 2 Type II and GDPR compliant**, with encryption, secure data storage, and role-based access controls to keep sensitive health information safe. While Paperform is not HIPAA compliant, it offers robust security features suitable for pre-screening and non-diagnostic patient intake in many clinical settings.

Whether you're a solo practitioner or a multi-location vision center, this template scales with your practice—from a few screenings per week to hundreds of patient inquiries per month.

Start pre-qualifying LASIK candidates faster, reduce administrative burden, and deliver a modern, professional patient experience from the very first touchpoint.
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