1. What is your age group?

Under 18

19-39

40-59

60+

2. Without my glasses and contacts... (check all that apply)

Farsightedness : Difficulty reading and seeing things up close

Nearsightedness : Difficulty driving and seeing things far away

Astigmatism : Distorted vision and cannot see very well in general

3. What do you usually wear? (check all that apply)

Glasses

Contacts

Reading Glasses

None of Them

4. Do you have any of the following? (check all that apply)

5. Have you been told you have cataracts and require surgery?

Are the following statements important to you?

6. I would like to see well at a distance without relying on glasses and contact lenses.

7. I would like to see well up close without relying on glasses and contact lenses.

8. It is important to me to see well at night after cataract surgery.

9. Think about the things in life you want to do without depending on glasses after cataract surgery. Which group is the most important? (check all that apply)

10. Would you like to speak with one of our specialists?

Can we text you?