What is your age group?

 Under 18 18 - 40 40 - 65 Over 65

Have you noticed any deterioration of your vision in the past 5 years?

 Yes No

Without my glasses and/or contacts: (check all that apply)

 I have trouble reading and seeing things up close I have trouble driving and seeing things that are far away

What do you usually wear? (check all that apply)

 Contact Lenses Reading Glasses Bifocals/Trifocals/Progressives

Describe your vision. (check all that apply)

 Blurry and/or cloudy Not as colorful or vibrant as it used to be Glare and/or halos around lights Poor night vision None of the above

Yes, I would like to schedule a FREE exam or consultation. The best time to call me is:

 8am - 12pm 12pm - 5pm

Are you interested in seeing well up close (reading) without glasses after your cataract surgery?

 Yes No

If you had to wear glasses after your vision treatment for one of the following activities, which one would you most be willing to wear glasses for (check all that apply)

 Reading fine print Using a computer or cooking Driving a car

If you could have good vision for distance and computer work without glasses, would you be willing to wear glasses for reading fine and small print?

 Yes No

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Select a Location

San FranciscoMountain View / San JoseWalnut CreekSanta Rosa

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