To start, please tell us how old you are:
Have you ever been told you have astigmatism?
Do you have to wear glasses/contacts for...?
Have you had any of the following procedures on your eyes (LASIK, PRK, RK, Cataract Surgery)?
Do you suffer from multiple sclerosis, lupus, keratoconus or diabetic retinopathy?
What email should we send the results to?
What is your first name?
What is your last name?
What phone number can we use to call/text you?
