Jacksonville Eye Doctor - Optometrist Jacksonville Beach - Eye Exams in Jacksonville and Jacksonville Beach

Online Quiz

This online quiz can be used to help determine candidacy for Corneal Refractive Therapy, a customized
treatment that can help you become free from glasses or contact lenses throughout the day. If you are
interested in learning more about Corneal Refractive Therapy, please call our office today!

Part A

I am a flexible easy going person.
yes no

I adjust to change rather easily.
yes no

I have never been able to wear regular contact lenses successfully before.
yes no

I would be satisfied if my natural vision were greatly improved, even if I still had
to wear lenses some of the time.
yes no

Having to depend on glasses and/or regular contact lenses to have clear vision bothers me.
yes no

I am not a perfectionist.
yes no

I often wish I did not have to wear corrective lenses.
yes no

I feel my appearance is better without glasses.
yes no

New career opportunities would be open to me if I did not have to wear glasses
or regular contacts.
yes no

Good vision without glasses or regular contacts is more important than having
great vision with them.
yes no

I find my participation in sports and other activities is restricted by wearing corrective
lenses.
yes no

I fear that I would be totally disabled if I lost my regular contacts or broke my
glasses.
yes no

Part B

I tend to be a perfectionist.
yes no

If after the Corneal Refractive Therapy or refractive surgery I still needed to wear corrective lenses I would be upset or frustrated.
yes no

It doesn't bother me to wear glasses or regular contact lenses. They give me excellent vision for all activities, are comfortable and are not a hassle to handle.
yes no
I don't accept change easily.
yes no
When things don't happen in just the way I had planned or expected I get upset or stressed easily.
yes no
If I did not end up with perfect vision after my procedure I would be upset and consider the experience a failure.
yes no
I don't mind wearing glasses and would feel uncomfortable without them.
yes no
I am aware of restrictions regarding my position with my employer that pertain to Corneal Refractive Therapy or laser vision correction. If you are uncertain, please ask - it's your responsibility.
yes no

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