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LASIK Evaluation

Cataract Evaluation

Select your age group*

Under 18
19-39
40-59
60+

Were your first glasses more for reading or distance?*



Have you noticed any deterioration of your vision in the past 5 years?*

Yes
No

Without my glasses and contacts*


I have trouble reading and seeing things up close

I have trouble driving and seeing things that are far away

I've been told that I have astigmatism

What do you usually wear?*


Glasses

Contacts

Reading Glasses

Describe your vision

Blurry or cloudy
Not as colorful or vibrant as it used to be
Halos around lights and/or over-sensitivity to light
Poor at night
Double or multiple images in one eye
None of the above

When was the last time you visited an eye doctor?

< 6 months
6 months - 1 year
> 1 year

Please provide us with the following contact information so that our executive can get in touch with you.