Self Test

WELCOME TO YOUR VISION SELF TEST

TO START

PLEASE TELL US HOW OLD YOU ARE

Under 18

19-39

40-55

56+

QUESTION 2:

HAVE YOU EVER BEEN TOLD YOU HAVE ASTIGMATISM?

Yes

QUESTION 3:

DO YOU HAVE TO WEAR GLASSES/CONTACTS FOR?

Driving

Computer

Reading

All of the above

QUESTION 4:

HAVE YOU HAD ANY OF THE FOLLOWING PROCEDURES ON YOUR EYES (LASIK, PRK, RK, CATARACT SURGERY)?

Yes

QUESTION 5:

DO YOU SUFFER FROM MULTIPLE SCLEROSIS, LUPUS, KERATOCONUS OR DIABETIC RETINOPATHY?

Yes

QUESTION 6:

IF YOU WERE TO COME IN FOR A CONSULTATION, WHICH LOCATION WOULD WORK BEST FOR YOU?

Please Choose A Location

QUESTION 7:

WHAT EMAIL SHOULD WE SEND THE RESULTS TO?

QUESTION 8:

WHAT IS YOUR FIRST NAME?

QUESTION 9:

WHAT IS YOUR LAST NAME?

Last Name

QUESTION 10 (THE FINAL ONE!):

WHAT PHONE NUMBER CAN WE USE TO CALL/TEXT YOU?

Phone

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Time Limit Reached

Question 1 of 10

Unfortunately you are not a candidate for RLE or ICL due to your age (18 or under). If you entered this age by mistake, refresh the page and select your age again.

Unfortunately you are not a candidate for RLE or ICL due to having one of the pre-existing medical conditions that were listed. If you entered that you have one of those pre-existing conditions by mistake, refresh the page and select your choice again.