How did you hear about Boston Vision?(Required)

Have you had an evaluation before?(Required)

Yes

No

What is the reason you have not moved forward with vision correction in the past?(Required)

Fear of the procedure

Cost of the procedure

Timing

Other

Boston Vision offers interest-free financing, is this something you are interested in?(Required)

Yes

No

Have you heard of the EVO ICL procedure?(Required)

Yes, and I would be interested in this procedure

Yes, but I prefer not to have this procedure

No, but I would like to learn more

Have you heard of the Clear Lens Exchange procedure?(Required)

Yes, and I would be interested in this procedure

Yes, but I prefer not to have this procedure

No, but I would like to learn more

Without your corrective lenses, do you have…(Required)

Trouble seeing far away

Trouble seeing up close

Overall blurry vision

Trouble with reading only

Do you wear…(Required)

Glasses

Glasses & Contacts

Contacts

Neither

Submit Your Personal Information

Confirm your age:(Required)

Select location preference:(Required)

This field is hidden when viewing the form

liine_guid_ph

Which would you prefer?