Falls Church, VA
703-912-0504
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Team
Anh Nguyen, M.D.
Lamise Rajjoub, M.D.
Lorena Sepsakos, M.D.
David L. Parver, M.D.
Roshni Patel, O.D.
Hayley Bui, O.D.
LASIK
LASIK Self-Test
PRK
EVO ICL
Cataract
Laser Cataract Surgery
Lens Implants
Light Adjustable Lens
Services
Chalazion
Contact Lenses
Cornea Problems
Keratoconus
Corneal Transplant
DMEK
Cross-Linking in Arlington, VA
Dry Eye
Glaucoma
Orthokeratology
Pterygium
Refraction
Retina Problems
Flashes and Floaters
Macular Degeneration
Blepharoplasty
Ptosis Surgery
Resources
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Procedure of Interest
Cataract Surgery
Chalazion
Dry Eye
Flashes and Floaters
Glaucoma
Keratoconus
Lens Implants
Macular Degeneration
Pterygium
Refraction
Cataract Surgery
Cornea Surgery
Cosmetic Procedures
Laser Vision Correction
Retina
Ortho-K
EVO ICL
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*Hours may vary. Please contact us for questions about scheduling
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Cataract Self-Test
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Cataract Self-Test
Cataract Self-Test
First Name
*
Last Name
*
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*
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1.How interested are you in seeing at a distance, driving or playing golf without glasses after your cataract surgery?
Select Your Answer
It is very important to me NOT to wear glasses for distance vision.
It is not important to me. I do not mind wearing glasses.
2.Are you interested in seeing well up close (reading) without glasses after your cataract surgery?
Select Your Answer
It is very important to me NOT to wear reading glasses.
It is not important to me. I do not mind wearing reading glasses to see things up close.
3.If you had to wear glasses after your vision treatment for one of the following activities, which one would you to most be willing to wear glasses for?
Select Your Answer
Reading fine print
Using a computer or cooking
Driving a car
4.If you could have good vision for driving during the day without glasses, and good near vision without glasses in most situations, would you be able to tolerate some halos and glare around lights at night?
Select Your Answer
Yes
No
5.If you could have good distance vision day and night, and good vision for computer work, without glasses, would you be willing to wear glasses for reading fine print and small type?
Select Your Answer
Yes
No
6.In our daily lives there are different things we do that require us to SEE at different distances. We have grouped some of these vision activities into 5 lifestyle zones. Think about the things in life you want to do the most without depending on glasses after cataract surgery. Which group is the most important
Select Your Answer
Newsprint, books, reading maps or sewing.
Computer screens, menus, price tags or headlines.
Watching TV, cooking, cleaning or indoor activities.
Driving, playing golf, seeing road signs.
Night driving, watching movies.
7. Consider your personality. Based on the options scale below how would you rank your personality?
Select Your Answer
Easy Going
In the middle
Perfectionist
*Hours may vary. Please contact us for questions about scheduling
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DOB
MM slash DD slash YYYY
Procedure of Interest
(Required)
Procedure of Interest
Chalazion
Dry Eye
Flashes and Floaters
Glaucoma
Keratoconus
Lens Implants
Macular Degeneration
Pterygium
Refraction
Cataract Surgery
Cornea Surgery
Cosmetic Procedures
Laser Vision Correction
Retina
Ortho-K
EVO ICL
Insurance information (carrier and policy number)
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Message
*Hours may vary. Please contact us for questions about scheduling
Δ
Team
▼
Anh Nguyen, M.D.
Lamise Rajjoub, M.D.
Lorena Sepsakos, M.D.
David L. Parver, M.D.
Roshni Patel, O.D.
Hayley Bui, O.D.
LASIK
▼
LASIK Self-Test
PRK
EVO ICL
Cataract
▼
Laser Cataract Surgery
Lens Implants
Light Adjustable Lens
Services
▼
Chalazion
Contact Lenses
Cornea Problems
▼
Keratoconus
Corneal Transplant
DMEK
Cross-Linking in Arlington, VA
Dry Eye
Glaucoma
Orthokeratology
Pterygium
Refraction
Retina Problems
▼
Flashes and Floaters
Macular Degeneration
Blepharoplasty
Ptosis Surgery
Resources
▼
Patient Forms
Blog
Patient Financing
Reviews
Pay Bill
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ANO MD PC
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Dr. Nguyen, MD
Dr. Patel, OD
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Message
Procedure of Interest
Cataract Surgery
Chalazion
Dry Eye
Flashes and Floaters
Glaucoma
Keratoconus
Lens Implants
Macular Degeneration
Pteryium
Refraction
Cornea Surgery
Cosmetic Procedures
Laser Vision Correction
Retina
Ortho-K
EVO ICL
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