Are You a Candidate for Cataract Surgery? Take the 60 Second Self-Test to Find Out! Step 1 of 9 11% First Name(Required)Last Name(Required)Phone(Required)Email(Required) Do we have consent to text you?(Required)YESNO What is your age range?(Required) Under 50 50-60 Over 60 Have you ever been diagnosed with Cataracts?(Required) Yes No Do you wear glasses or contacts to correct your vision?(Required) No Prescription Glasses Reading Glasses Contact Lenses Are you having difficulty driving at night?(Required) Yes No Do you have difficulty seeing street signs while driving?(Required) Yes No Are nearby and distant objects not as clear as they used to be?(Required) Yes No Do colors seem less bright?(Required) Yes No Have you had an eye exam in the last year?(Required) Yes No NameThis field is for validation purposes and should be left unchanged.
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