0% Age

1

What is your age group?
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2

Without my glasses and contacts... (Check All That Apply)
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3

What do you usually wear? (Check All That Apply)
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4

Do you have any of the following? (Check All That Apply)
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5

I would like to see well at a distance without relying on glasses and contact lenses.

Rate this statement on a scale of 1 to 5 with 1 being the lowest.
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6

I would like to see well up close without relying on glasses and contact lenses.

Rate this statement on a scale of 1 to 5, with 1 being the lowest.
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7

Would your lifestyle improve if you were to become less dependent on glasses and contact lenses?
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8

Would you like to speak with our Laser Vision Correction Team?
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