Cataract Self-Evaluation

If you would like to learn more about whether or not you may be eligible for cataract surgery, take our self-evaluation survey and someone from our office will contact you with more information about your options.

First Name *

Last Name *

Email *

Phone *

What is your occupation?

What are your favorite hobbies/recreational activities?

Have you ever had prior eye surgery?

Yes

No

What is your current age group?

Under 18

18-40

40-65

Over 65

At what age did you start wearing glasses?

Under 40

40-55

Over 55

Have you noticed any deterioration of your vision during the last five years?

Yes

No

Is your vision (select all that apply):

Nearsighted (trouble seeing far away)

Farsighted (trouble seeing close-up)

Astigmatism (double images)

Wear bifocals or over-the-counter reading glasses

It is most important for your to have (select all that apply):

Good distance vision (driving/golfing/watching TV)

Good intermediate vision (computer work)

Good close-up vision (reading)

If you have cataract surgery, how important is it for you to be free of glasses and contacts afterwards?

Very important

Not important

Not sure

Sign up to receive our newsletter and special offers?

Yes

No

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If you are human, leave this field blank.

Cataract Examination

During your Cataract Examination, our doctors will answer any questions you may have and assess your options for improving your vision.

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Live Cataract Seminar

Want to learn more about High Definition Laser Cataract Surgery? Join us for our next seminar with Dr. Michael Vrabec.

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