Cataract Self Test

Before we get started, can you fill in your email address below? We'll send you the results!
What is your first and last name?
Do you have trouble with glare from the sun or night driving?
Yes
No
Has your vision worsened for distance (such as reading street signs) or for near tasks (such as seeing small print)?
Yes
No
Are you interested in seeing well far away (distance) without glasses?
It's very important to me NOT to wear distance glasses.
It's not important to me. I do not mind wearing distance glasses to see things far away.
Are you interested in seeing well up close (reading) without glasses?
It's very important to me NOT to wear reading glasses.
It's not important to me. I do not mind wearing reading glasses to see things up close.
Would your lifestyle activities improve if you were to become less dependent on glasses and/or contact lenses?
Yes
Maybe
No
The results of cataract surgery have been tremendous for literally millions of people. Despite the amazing safety and results of this procedure there are associated risks. Are you willing to discuss these risks with our surgical coordinators?
Yes
No
You're almost done! What's the best phone number for us to reach you at?
{"name":"Cataract Self Test", "url":"https://www.quiz-maker.com/Q0ZE5NH","txt":"Do you have trouble with glare from the sun or night driving?, Has your vision worsened for distance (such as reading street signs) or for near tasks (such as seeing small print)?, Are you interested in seeing well far away (distance) without glasses?","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}
Quiz Maker Logo Make your own Quiz
Powered by: Quiz Maker