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1

What is your age group?

2

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

3

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

4

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.

5

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.

6

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

7

Which Procedure Are You Interested In?