Question 1/19

Do you wear corrective lenses?

Question 2/19

How do you rate your vision?

Question 3/19

What form of corrective lenses do you use? (click all that apply)


Question 4/19

What brand(s) of contact lenses have you used?


Question 5/19

Are fashionable frames important for you when selecting your Eyeglasses?

Question 6/19

Do you have prescription sunglasses?

Question 7/19

Do you require bifocals?

Question 8/19

Which form of corrective Lenses do use them with?


Question 9/19

Are you near or far sighted?

Question 10/19

Have you considered Corrective Surgery?

Question 11/19

How far along in the process are you?


Question 12/19

Do you have astigmatism?

Question 13/19

Do you have cataracts?

Question 14/19

Are you considering surgery for your cataracts?

Question 15/19

Have you been diagnosed with glaucoma?

Question 16/19

Do you currently have medical insurance?

Question 17/19

Please select your current medical provider

Question 18/19

What is the name of your provider?

Question 19/19

lease select the current medical coverage you have