Find out if you are a candidate Are you considering LASIK or cataract surgery? Complete this survey to find out if you’re a candidate:Choose Eye Health Survey *LasikCataractCataract Surgery Candidacy Survey Please fill out the form below to get startedFirst Name *Last NamePhone *Email Address *LASIK Surgery Candidacy Survey Please fill out the form below to get startedFirst Name *Last NamePhone *Email Address *Cataract Surgery Candidacy Survey What is Your Age Range?Under 1819 – 3940 – 5960+LASIK Surgery Candidacy Survey What is Your Age Range?Under 1819 – 3940 – 5960+Cataract Surgery Candidacy Survey Without My Glasses or ContactsFarsightednessNearsightednessAstigmatismLASIK Surgery Candidacy Survey Without My Glasses or ContactsFarsightednessNearsightednessAstigmatismCataract Surgery Candidacy Survey What Do You Usually Wear?GlassesContactsReading GlassesNoneLASIK Surgery Candidacy Survey What Do You Usually Wear?GlassesContactsReading GlassesNoneCataract Surgery Candidacy Survey Do You Have Any of the Following Health Conditions?Rheumatoid ArthritisMultiple SclerosisLupusCataractsKeratoconusDiabetic RetionopathyPrior Eye SurgeryPrior Eye InjuryPregnant or NursingNoneLASIK Surgery Candidacy Survey Do You Have Any of the Following Health Conditions?Rheumatoid ArthritisMultiple SclerosisLupusCataractsKeratoconusDiabetic RetionopathyPrior Eye SurgeryPrior Eye InjuryPregnant or NursingDry EyesNoneCataract Surgery Candidacy Survey Have You Been Told You Have Cataracts and Require Surgery?YesNoNot SureLASIK Surgery Candidacy Survey Rate This Statement on a Scale of 1 to 5 With 1 Being the Lowest.I would like to see well at a distance without relying on glasses and contact lenses. *12345Cataract Surgery Candidacy Survey Are the Following Statements Important to You? (Check all that apply.)I would like to see well at a distance without relying on glasses and contact lenses. *YesNoNot SureI would like to see well up close without relying on glasses and contact lenses. *YesNoNot SureIt is important to me to see well at night after cataract surgery. *YesNoNot SureThink about the things in life you want to do without depending on glasses after cataract surgery. Which group is the most important? *See Far AwaySee Medium DistanceSee Close UpSee Very CloseLASIK Surgery Candidacy Survey Rate This Statement on a Scale of 1 to 5 With 1 Being the Lowest.I would like to see well up close without relying on glasses and contact lenses. *12345Cataract Surgery Candidacy Survey Are You Ready to Schedule an Appointment?YesI Want More InformationNoLASIK Surgery Candidacy SurveyWould your lifestyle improve if you were to become less dependent on glasses and contact lenses? *YesNoAre You Ready to Schedule and Appointment? *YesI Would Like More InformationNo SubmitPlease do not fill in this field. Please do not fill in this field.
