Corneal Associates

Are You A Candidate for Cataract Surgery?

How old are you?

You have difficulty seeing: Far, Near, Both?

What type of vision correction do you wear?

How would your life improve be improving your vision?

What kind of work do you do?

What hobbies and activities are important to you?

If you prefer, our counselor could call, email, or mail information to you. (We would never distribute or sell address, phone or email lists.) When is the best time to call?

General Info

Name:

Phone:

E-Mail:

Address:

State:

Zip:

Have you been told that you are a candidate for cataract surgery?

10.

If you have been told that you are not a candidate for cataract surgery, would you like to hear about other possible options?

11.

Many patients tell us that deciding on vision correction surgery is a process. Where are you in the decision making process?

12.

3 + 9 =

APPOINTMENT

LASIK Self Candidacy Test

Cataracts Self Candidacy Test

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Are You A Candidate for Cataract Surgery?