Cataract Self-Test Call Today Contact Us "*" indicates required fields What is your age group?* Under 18 19-39 40-59 60+ Without my glasses and contacts... (check all that apply)* Farsightedness: I have trouble reading and seeing things up close Nearsightedness: I have trouble driving and seeing things far away Astigmatism: I have distorted vision and cannot see very well What do you usually wear? (check all that apply)* Prescription Glasses Contacts Reading Glasses None of Them Do you have any of the following? (check all that apply)* Rheumatoid Arthritis Multiple Sclerosis Prior eye injury Keratoconus Diabetic Retinopathy None of above Pregnant or nursing Lupus Have you been told you have cataracts and require surgery?* Yes No Are the following statements important to you?I would like to see well at a distance without relying on glasses and contact lenses.* Yes No I'm not sure I would like to see well up close without relying on glasses and contact lenses.* Yes No I'm not sure It is important to me to see well at night after cataract surgery.* Yes No I'm not sure Think about the things in life you want to do without depending on glasses after cataract surgery. Which group is the most important? (check all that apply)* Seeing Far Away (TV, night driving, golfing) Seeing Close Up (Newsprint, maps, books) Seeing Intermediate Distances (Computer, cooking, iPad) Seeing Very Close (Embroidery, sewing and other crafting, puzzles) Your Vision Deserves Clarity Thank you for completing the Cataract Self-Test. While this test is not a substitute for a comprehensive cataract evaluation, your responses suggest it is time to schedule your evaluation.Schedule Your Consultation Take control of your vision today—click YES to schedule a personalized cataract evaluation with our team. We’ll walk you through your options and help you determine the best path forward to clearer, brighter vision.First / Last Name* First Last Phone Number*Email Address* Date of Birth* MM slash DD slash YYYY Consent* Do you consent to receive text communications from Brooks Eye Associates*Consent* Do you consent to receive email communications from Brooks Eye Associates* Δ
