{"id":1127,"date":"2019-11-14T14:50:10","date_gmt":"2019-11-14T14:50:10","guid":{"rendered":"http:\/\/oomc.devserv.co\/kremer\/?page_id=1127"},"modified":"2019-12-10T21:11:20","modified_gmt":"2019-12-10T21:11:20","slug":"lasik-self-test","status":"publish","type":"page","link":"https:\/\/oomc.devserv.co\/kremer\/lasik-self-test\/","title":{"rendered":"LASIK Self-Test"},"content":{"rendered":"<p>By completing this LASIK self-test, we will better understand if you might be a candidate for LASIK. This LASIK self-test is not a substitute for a proper medical evaluation, and is simply a guide to help Kremer Eye Center answer your questions and discuss your specific needs. Please ask your regular eye doctor if they think you might be a candidate, or schedule your free LASIK Consultation at one of our 8 locations.<br \/>\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1130-o1\" lang=\"en-US\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/kremer\/wp-json\/wp\/v2\/pages\/1127#wpcf7-f1130-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"1130\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.9.5\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1130-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<div class=\"partners-form-item full\">\n\t<p class=\"radio-title\">What is your age?\n\t<\/p>\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"age\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"age\" value=\"Under 18\" \/><span class=\"wpcf7-list-item-label\">Under 18<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"age\" value=\"19\u201340\" \/><span class=\"wpcf7-list-item-label\">19\u201340<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"age\" value=\"41\u201369\" \/><span class=\"wpcf7-list-item-label\">41\u201369<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"age\" value=\"70+\" \/><span class=\"wpcf7-list-item-label\">70+<\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n<div class=\"partners-form-item full\">\n\t<p class=\"radio-title\">I wear (choose all that apply):\n\t<\/p>\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"wear\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"wear[]\" value=\"Contacts\" \/><span class=\"wpcf7-list-item-label\">Contacts<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"wear[]\" value=\"Glasses\" \/><span class=\"wpcf7-list-item-label\">Glasses<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"wear[]\" value=\"Reading Glasses\" \/><span class=\"wpcf7-list-item-label\">Reading Glasses<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"wear[]\" value=\"None\" \/><span class=\"wpcf7-list-item-label\">None<\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n<div class=\"partners-form-item full\">\n\t<p class=\"radio-title\">Has your prescription changed over the last 2 years?\n\t<\/p>\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"prescription\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"prescription\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"prescription\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n<div class=\"partners-form-item full\">\n\t<p class=\"radio-title\">Are you currently nursing, pregnant, or planning to get pregnant in the near future?\n\t<\/p>\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"pregnant\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"pregnant\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"pregnant\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n<div class=\"partners-form-item full\">\n\t<p class=\"radio-title\">What are you looking for in a LASIK Center? (choose all that apply):\n\t<\/p>\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"looking\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"looking[]\" value=\"Financing\" \/><span class=\"wpcf7-list-item-label\">Financing<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"looking[]\" value=\"Technology\" \/><span class=\"wpcf7-list-item-label\">Technology<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"looking[]\" value=\"Results\" \/><span class=\"wpcf7-list-item-label\">Results<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"looking[]\" value=\"Experience \/ Reputation of Surgeon\" \/><span class=\"wpcf7-list-item-label\">Experience \/ Reputation of Surgeon<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"looking[]\" value=\"Cost\" \/><span class=\"wpcf7-list-item-label\">Cost<\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n<div class=\"partners-form-item full\">\n\t<p class=\"radio-title\">Did your eye doctor talk to you about Kremer Eye Center?\n\t<\/p>\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"doctor\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"doctor\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"doctor\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n<div class=\"partners-form-item full\">\n\t<p class=\"radio-title\">I authorize a Kremer Eye Center representative to contact me to discuss the results of my LASIK Self-Test. I acknowledge that the information provided in this questionnaire will be used to send additional information about offers related to our services.\n\t<\/p>\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"authorize\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"authorize[]\" value=\"Yes, authorize.\" \/><span class=\"wpcf7-list-item-label\">Yes, authorize.<\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n<div class=\"partners-form-item\">\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"first-name\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"First Name\" value=\"\" type=\"text\" name=\"first-name\" \/><\/span>\n\t<\/p>\n<\/div>\n<div class=\"partners-form-item\">\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"last-name\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Last Name\" value=\"\" type=\"text\" name=\"last-name\" \/><\/span>\n\t<\/p>\n<\/div>\n<div class=\"partners-form-item full birthday\">\n\t<p><span class=\"birthday-title\">Date of Birth<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"birdth-month\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"MM\" value=\"\" type=\"text\" name=\"birdth-month\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"birdth-day\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"DD\" value=\"\" type=\"text\" name=\"birdth-day\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"birdth-year\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"YYYY\" value=\"\" type=\"text\" name=\"birdth-year\" \/><\/span>\n\t<\/p>\n<\/div>\n<div class=\"partners-form-item\">\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"email\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Email\" value=\"\" type=\"email\" name=\"email\" \/><\/span>\n\t<\/p>\n<\/div>\n<div class=\"partners-form-item\">\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"phone\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Phone Number\" value=\"\" type=\"text\" name=\"phone\" \/><\/span>\n\t<\/p>\n<\/div>\n<div class=\"partners-form-item full\">\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"st-adderss\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Street Address\" value=\"\" type=\"text\" name=\"st-adderss\" \/><\/span>\n\t<\/p>\n<\/div>\n<div class=\"partners-form-item\">\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"citye\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"City\" value=\"\" type=\"text\" name=\"citye\" \/><\/span>\n\t<\/p>\n<\/div>\n<div class=\"partners-form-item\">\n\t<div class=\"partners-form-item\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"state\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" id=\"partners-address-state\" aria-required=\"true\" aria-invalid=\"false\" name=\"state\"><option value=\"State\">State<\/option><option value=\"AL\">AL<\/option><option value=\"AK\">AK<\/option><option value=\"AZ\">AZ<\/option><option value=\"AR\">AR<\/option><option value=\"CA\">CA<\/option><option value=\"CO\">CO<\/option><option value=\"CT\">CT<\/option><option value=\"DE\">DE<\/option><option value=\"FL\">FL<\/option><option value=\"GA\">GA<\/option><option value=\"HI\">HI<\/option><option value=\"ID\">ID<\/option><option value=\"IL\">IL<\/option><option value=\"IN\">IN<\/option><option value=\"IA\">IA<\/option><option value=\"KS\">KS<\/option><option value=\"KY\">KY<\/option><option value=\"LA\">LA<\/option><option value=\"ME\">ME<\/option><option value=\"MD\">MD<\/option><option value=\"MA\">MA<\/option><option value=\"MI\">MI<\/option><option value=\"MN\">MN<\/option><option value=\"MS\">MS<\/option><option value=\"MO\">MO<\/option><option value=\"MT\">MT<\/option><option value=\"NE\">NE<\/option><option value=\"NV\">NV<\/option><option value=\"NH\">NH<\/option><option value=\"NJ\">NJ<\/option><option value=\"NM\">NM<\/option><option value=\"NY\">NY<\/option><option value=\"NC\">NC<\/option><option value=\"ND\">ND<\/option><option value=\"OH\">OH<\/option><option value=\"OK\">OK<\/option><option value=\"OR\">OR<\/option><option value=\"PA\">PA<\/option><option value=\"RI\">RI<\/option><option value=\"SC\">SC<\/option><option value=\"SD\">SD<\/option><option value=\"TN\">TN<\/option><option value=\"TX\">TX<\/option><option value=\"UT\">UT<\/option><option value=\"VT\">VT<\/option><option value=\"VA\">VA<\/option><option value=\"WA\">WA<\/option><option value=\"WV\">WV<\/option><option value=\"WI\">WI<\/option><option value=\"WY\">WY<\/option><\/select><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"partners-form-item\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"zip\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Zip Code\" value=\"\" type=\"text\" name=\"zip\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"clearfix\">\n<\/div>\n<div class=\"partners-form-item-button\">\n\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner section-button section-button-small\" type=\"submit\" value=\"Submit\" \/>\n\t<\/p>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/p>\n","protected":false},"excerpt":{"rendered":"<p>By completing this LASIK self-test, we will better understand if you might be a candidate for LASIK. This LASIK self-test is not a substitute for a proper medical evaluation, and is simply a guide to help Kremer Eye Center answer your questions and discuss your specific needs. Please ask your regular eye doctor if they [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-self-test.php","meta":{"inline_featured_image":false,"footnotes":""},"class_list":["post-1127","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/oomc.devserv.co\/kremer\/wp-json\/wp\/v2\/pages\/1127","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/oomc.devserv.co\/kremer\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/oomc.devserv.co\/kremer\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/oomc.devserv.co\/kremer\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/oomc.devserv.co\/kremer\/wp-json\/wp\/v2\/comments?post=1127"}],"version-history":[{"count":7,"href":"https:\/\/oomc.devserv.co\/kremer\/wp-json\/wp\/v2\/pages\/1127\/revisions"}],"predecessor-version":[{"id":1131,"href":"https:\/\/oomc.devserv.co\/kremer\/wp-json\/wp\/v2\/pages\/1127\/revisions\/1131"}],"wp:attachment":[{"href":"https:\/\/oomc.devserv.co\/kremer\/wp-json\/wp\/v2\/media?parent=1127"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}