Are you at least 18 years old?YesNo

Do you wear:GlassesContactsBothNeither

Have you been considering LASIK surgery?YesNo

Have you been considering Dry Eye Treatment?YesNo

Have you been considering cataract surgery?YesNo

Have you had any major fluctuations in your vision in the past year?YesNo

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Yes, I would like to receive more information from the May Eye Care Center.

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