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Fraser Eye Care Center
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CataractsOnline Self Evaluation

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Fraser Eye / Cataract Overview / Cataract Online Self Evaluation

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Cataract Self Evaluation

Q1: I am: (select your age group)*(Required)
Q2. Without glasses and/or contacts: (check all that apply)*(Required)
Q3. What do you usually wear? (check all that apply)*(Required)
Q4. Identify symptoms you have: (check all that apply)*(Required)
Q5: Have you had any previous eye operations?: (check all that apply)*(Required)
Q6. Have you ever been told you have Cataracts and need surgery?*
Q7. After cataract surgery:*(Required)
Would you like to be contacted to schedule a cataract consultation?*(Required)
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