What is you age group?
*
30 - 45
45 - 50
50 - 60
Over 60
Do you have any health problems that make it risky for you to have cataract surgery?
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Yes
No
Do you have any other eye problems that might affect how well you can see after cataract surgery?
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Yes
No
Do you need good vision for activities like reading, driving, or playing sports?
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Yes
No
Do you have a clear idea of what you can expect from cataract surgery and the lenses you might choose?
*
Yes
No
Great. Who should we send the results to?
*
Thanks. What's your email?
*
And the best number to contact you?
*