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Are you considering eye surgery?
Trust your vision to South Florida's most experienced eye surgery center. We are currently offering $500 off on any of our 5 vision correction procedures.
8
Questions
Self-evaluation test
1
What is your age?
18-30
31-40
40-60
60+
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2
What vision aids do you currently use?
Prescription glasses
Contact lenses
Reading Glasses
Bifocals
None
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3
What vision problems are you having?
Select all that apply.
Nearsightedness, Farsightedness, or Astigmatism
Blurry reading vision
Cloudy/hazy vision
Double vision
None
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4
Do you have any symptom of dry eye?
Constantly watering eyes
Itchy eyes
Redness
Gritty or sand feeling
Feeling of foreign object in eyes
None of these
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5
Can we get your name?
*
This field is required.
First Name
Last Name
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6
What is your email?
*
This field is required.
example@example.com
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7
What is your date of birth?
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8
What is your phone number?
*
This field is required.
Area Code
Phone Number
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