St. Lukes - Cataract Self Test

1. How old are you?*
Please note: We do not treat patients under the age of 18
LIINE HOW OLD ARE YOU

2. Without my glasses and contacts...(Check All That Apply) *
LIINE WITHOUT GLASSES/CONTACTS

3. What do you usually wear? (Check All That Apply) *
LIINE WHAT DO YOU USUALLY WEAR

4. Have you been told you have cataracts and require surgery?*

YesNo

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

YesNoI'm not sure
6. I would like to see well up close without relying on glasses and contact lenses.*

YesNoI'm not sure
7. It is important to me to see well at night after cataract surgery.*

YesNoI'm not sure

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

I'm ready to book my consultation!Yes, please call me to discuss my options.I'm not ready yet.