Vision Correction Self-evaluation

Vision Correction

Take the self-evaluation to determine if you're eligible

1. Do you wear: *
(Select all that apply)

Contacts
Glasses
Readers
Bifocals/Trifocals
None

2. Without using corrective lenses, I have trouble seeing at: *
(Select all that apply)

Near
Distance
Intermediate

3. Have you ever been told that you have astigmatism? *

Yes
No

4. Do you have any of the following? *
(Select all that apply)

Cataracts
Previous Eye Injury
Glaucoma
None

5. If you are over 40, would you be willing to wear reading glasses for close up activities following vision correction? *

Yes
No
Not Applicable

6. Do you feel that your quality of life, career, or activities you do for enjoyment would be improved if you were less dependent on glasses or contacts? *

Yes
No

7. How did you hear about Grosinger, Spigelman & Grey Eye Surgeons? *

Google
Word of Mouth or Friend
Referral from Optometrist
Referral from Medical Doctor
Other

1. Do you wear:*
(Select all that apply)

Contacts
Glasses
Readers
Bifocals/Trifocals
None

2. Without using corrective lenses, I have trouble seeing at: *
(Select all that apply)

Near
Distance
Intermediate

3. Do you have any of the following? *
(Select all that apply)

Cataracts
Previous Eye Injury
Glaucoma
None

4. If you are over 40, would you be willing to wear reading glasses for close up activities following vision correction? *

Yes
No
Not Applicable

5. Have you noticed any deterioration of your vision in the last 5 years? *

Yes
No

6. Do you have trouble with glare when driving at night? *

Yes
No

7. Do you feel that your quality of life, career, or activities you do for enjoyment would be improved if you were less dependent on glasses or contacts? *

Yes
No

8. How did you hear about Grosinger, Spigelman & Grey Eye Surgeons? *

Google
Word of Mouth or Friend
Referral from Optometrist
Referral from Medical Doctor
Other

None, Previous Eye Injury

Well, this is exciting!
Based on your responses, you may be a candidate for the following vision correcting procedures.
Click on a procedure to learn more.

LASIK
Advanced Surface Ablation
Refractive Lens Exchange

Glaucoma

Based on your responses, we suggest that you come in for a comprehensive examination to determine the best way to improve your vision!

A comprehensive eye exam will allow our ophthalmologists to evaluate your medical history, the health of your eyes and detect early changes that otherwise might go unnoticed such as an increased eye pressure, diabetic eye changes, or even macular degeneration.
Click on the link to learn more about our comprehensive medical evaluations.

Comprehensive Medical Evaluation

Cataracts

Well, this is exciting!

Based on your responses, you may be a candidate for the following vision correcting procedures.Click on a procedure to learn more.

Cataract Surgery with a Premium IOL (intended to reduce or eliminate the need for glasses)
Refractive Lens Exchange

First Name *

Last Name *

Email *

Phone *