Cataract Self Test

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SightMD
SightMD
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How interested are you in seeing at a distance, driving, or playing golf without glasses after your cataract surgery?* This field is required.
It's very important that I NOT wear glasses after cataract surgery
It's not important, I don't mind wearing glasses
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Are you interested in seeing well up close (reading) without glasses after your cataract surgery?* This field is required.
It's very important that I NOT wear glasses after cataract surgery
It's not important, I don't mind wearing glasses
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If you had to wear glasses after your vision treatment for one of the following activities, which would you be most willing to wear glasses for?* This field is required.
Reading small text
Using a computer or cooking
Driving a car
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If you could have good vision for driving during the day without glasses, and good near vision without glasses in most situations, would you be able to tolerate some halos and glare around lights at night?* This field is required.
YESNO
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If you could have good distance vision day and night, and good vision for computer work, without glasses, would you be willing to wear glasses for reading fine print and small type?* This field is required.
YESNO
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In our daily lives there are different things we do that require us to SEE at different distances. Think about the things in life you want to do the most without depending on glasses after cataract surgery. Which group is the most important?* This field is required.
Newsprint, books, reading maps, or sewing
Computer screens, menus, price tags, or headlines
Watching TV, cooking, cleaning, or indoor activities
Driving, playing golf, seeing road signs
Night driving, watching movies
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When choosing your vision correction, which matters most to you?* This field is required.(check all that apply)
Affordability
Safety
Experience of the Doctor
Compassionate Care
Weekend Availability
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Which Practice are you looking to visit* This field is required.
SightMD New York
SightMD New Jersey
SightMD Pennsylvania
SightMD Connecticut
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Which SightMD New Jersey location is closest to you?* This field is required.
Barnegat
Toms River
Brick
Whiting
Spring Lake Heights
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Which SightMD New York location is closest to you?* This field is required.
Babylon
Bethpage
Brentwood
Bronx
Brooklyn
Deer Park
East Patchogue
Flushing
Garden City
Hampton Bays
Harrison
Hauppauge
Hewlett
Holbrook
Johnson City
Little Neck
Manhasset
New Rochelle
NYC
Plainview
Port Jefferson
Rockville Centre
Sayville
Smithtown
Southampton
Southold
West Islip
Yonkers
Yorktown Heights
Other
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Which SightMD Pennsylvania location is closest to you?* This field is required.
Elkins Park
Philadelphia
Pottsville
Shamokin
Wyomissing
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Which SightMD Connecticut is closest to you?* This field is required.
Enfield
Manchester
Norwalk
Torrington
Westport
Wilton
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Name* This field is required.
First Name
Last Name
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Email* This field is required.
example@example.com
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Phone Number* This field is required.
Area Code
Phone Number
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How did you hear about us?* This field is required.
Please Select
Please Select
Davis Vision
Employee Referral
Existing Patient
Facebook
Friend/Relative
Google
Instagram
Insurance
LASIK Open House
Longisland.com
MD Referral
OD Referral
Patient Referral
Real Self Website
sightmd.com
Street Team/Community Event
Yelp
ZocDoc
Other
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Do you consent to receive SMS messages from SightMD regarding your appointments, treatment, and other important updates?* This field is required.
YESNO
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Please verify that you are human* This field is required.
Should be Empty: