Select age group *
Under 18
19-39
40-59
60+
Have you been diagnosed with cataracts? *
Yes
No
When was your last optometrist appointment? *
Have you noticed any vision deterioration in the last 1-2 years? *
Yes
No
Without my glasses or contacts (select all that apply) *
I have trouble reading and seeing things up close
I have trouble driving and seeing things far away
I have been told I have astigmatisms
What do you usually wear? *
Glasses
Contacts
Reading glasses
None of the above
Describe your vision (select all that apply) *
Blurry or cloudy
Not as colorful or vibrant as it used to be
Halos around lights and/or over sensitivity to light
Poor at night
Double or multiple images in one eye
None of the above
Best way to contact you? *
Phone
Email
First name *
Last name *
Email *
Phone *
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