Survey 2 – age 55+ | Achieve Eye & Laser Specialists

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Age above 55

Age above 55

1

2

Have you had any previous eye surgeries or laser treatment? *

Yes
No

What procedure(s)? Check all that apply

LASIK
Cataract/Lens replacement
Other

Do you wear glasses or contacts? *

Yes
No

What do you wear your glasses or contacts for? (Choose one or both)

Reading
Distance vision

Name

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