LASIK Self-Test

FIND OUT IF YOU'RE A CANDIDATE

Please complete our Cataract Self Test and we will contact you to go over options for your custom cataract treatment.
First Name*
Last Name*
Email*
Phone*

How did you hear about us?
How did you hear about us?*
- 106.1 KISS FM
- 1310 The Ticket
- Google
- Facebook
- YouTube
- Doctor Referral
- Patient Referral
- Groupon
- Existing Patient
1. How interested are you in seeing at a distance, driving or playing golf without glasses after your cataract surgery?
2. Are you interested in seeing well up close (reading) without glasses after your cataract surgery?
3. If you had to wear glasses after your vision treatment for one of the following activities, which one would you to most be willing to wear glasses for?
4. If you could have good vision for driving during the day without glasses, and good near vision without glasses in most situations, would you be able to tolerate some halos and glare around lights at night?
5. If you could have good distance vision day and night, and good vision for computer work, without glasses, would you be willing to wear glasses for reading fine print and small type?
6. In our daily lives there are different things we do that require us to SEE at different distances. We have grouped some of these vision activities into 5 lifestyle zones. Think about the things in life you want to do the most without depending on glasses after cataract surgery. Which group is the most important
7. Consider your personality. Based on the options scale below how would you rank your personality?

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