Cataracts Self-Test Have you had any previous eye procedures? (Refractive Surgery / LASIK)*Select OneYesNoHave you been told you have cataracts?*Select OneYesNoWhat do you currently use to correct your vision?*Select OneGlassesContactsGlasses and ContactsReading glasses onlyI don't wear anything (but I should!)How often do you currently rely on readers, glasses or contacts to correct your vision?*Select OneFrequentlyOccasionallyRarelyNeverConsidering your personal and professional life, please check the one activity you do most often.*Select OneComputer WorkReadingDrivingPhysical ActivitiesI Use Long and Short Range Vision EquallyWhen considering Cataract Surgery, which matters most to you?*Select OneAffordabilitySafetyConvenienceExperience of the SurgeonAge Range*Select One18 - 2930 - 3940 - 5455 - 6465+Name* First Last Email* Phone Number*
