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Zarmeena Vendal, M.D.
Natalie Stanciu, M.D.
Stanley Saulny, M.D.
Catherine Makin, M.D.
Andrew Plummer, M.D.
Liana Renteria, O.D.
Austin Ophthalmologists
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Cataract Center
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First Name
(Required)
Last Name
(Required)
Phone
(Required)
Email
Can We Text You?
(Required)
Yes
No
What is your age group?
Under 18
19-39
40-59
60+
Without my glasses and contacts... (check all that apply)
Farsightedness: I have trouble reading and seeing things up close
Nearsightedness: I have trouble driving and seeing things far away
Astigmatism: I have distorted vision and cannot see very well
What do you usually wear? (check all that apply)
(Required)
Glasses
Contacts
Reading Glasses
None of Them
Do you have any of the following? (check all that apply)
(Required)
Rheumatoid Arthritis
Multiple Sclerosis
Lupus
Cataracts
Keratoconus
Diabetic Retinopathy
Prior Eye Surgery
Prior serious eye injury
None of the above
Have you been told you have cataracts and require surgery?
Yes
No
I would like to see well at a distance without relying on glasses and contact lenses.
(Required)
Yes
No
I'm not sure
I would like to see well up close without relying on glasses and contact lenses.
(Required)
Yes
No
I'm not sure
It is important to me to see well at night after cataract surgery.
(Required)
Yes
No
I'm not sure
Think about the things in life you want to do without depending on glasses after cataract surgery. Which group is the most important? (check all that apply)
(Required)
Seeing Far Away (TV, night driving, golfing)
Seeing Intermediate Distances (Computer, cooking, iPad)Second Choice
Seeing Close Up (Newsprint, maps, books)
Seeing Very Close (Embroidery, sewing and other crafting, puzzles)
Would you like to speak with our Laser Vision Correction Team?
I'm ready to book my consultation!
Yes, please call me to discuss my options.
I'm not ready yet
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