Questionnaire for the pre-procedure Flow 2.0 Eye Examination
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1.
Full name:
(Required.)
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2.
Age:
(Required.)
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3.
Personal code:
(Required.)
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4.
What's your current glasses prescription?
(Required.)
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5.
What kind of vision aids do you use?
(Required.)
I wear glasses
I wear contact lenses
I wear both glasses and contact lenses
I do not use vision aids
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6.
How much are you disturbed by glasses and contact lenses in your daily life?
(Required.)
1 – not at all
2 – a little
3 – moderately
4 – disturbed
5 – disturbed a lot
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7.
What are the situations where glasses and contact lenses bother you most? (You may choose multiple answers)
(Required.)
Work
Travel
Sports
Housework
Leisure
Wearing glasses makes me insecure
Other
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8.
How long have you been considering a laser procedure?
(Required.)
I have never thought of it before
Up to 1 month
1-3 months
Up to 1 year
1-3 years
Over 3 years
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9.
Why have you not had a laser eye procedure earlier?
(Required.)
I am used to wearing glasses and/or contact lenses
The procedure is expensive
I have not found time for the procedure
I am intimidated by the procedure
Other reason (Please specify)
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10.
What motivated you to come to the eye examination?
(Required.)
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11.
What most influences your decision on choosing an eye clinic for your procedure? (You may choose multiple answers)
(Required.)
Safety
Pricing
Professional credentials
100% vision guarantee
Customer service
Full package with pre- and post-procedure treatment
Other (Please specify)
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12.
If you had the opportunity to undergo the procedure tomorrow, would you have any doubts or questions?
(Required.)
No
Yes (Please specify)
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13.
Would your life quality improve without having to wear glasses and/or contact lenses?
(Required.)
No
Yes (Please specify, what kind of new opportunities do you see in a life without glasses?)
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14.
Do you have a person to discuss the final decision to undergo the laser procedure?
(Required.)
No
Yes, my husband/wife/partner
Yes, my friend
Yes, my parent or family member
Other (Please specify)
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15.
Do you have any friends who have had laser treatment?
(Required.)
No
Yes (Are they satisfied with the results?)
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16.
What is most important to you when choosing a laser procedure?
(Required.)
Quick recovery
Permanent results
No lifestyle restrictions in the future
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17.
If you qualify for the procedure, how soon would you plan to schedule?
(Required.)
As soon as possible
Within 2 weeks
Within 1-3 months
Within a year
Unsure, maybe some time in the future (Is there any factor that might delay the decision indefinitely?)
18.
How did you hear about KSA Vision Clinic?
I did my own research and searched online
I received a recommendation from a friend, acquaintance, or family member
I saw a post or advertisement on social media (Facebook, Instagram)
I saw information through another channel (e.g., a banner on Delfi, an article in Postimees, a video on TikTok, an advertisement in a gym, etc. Please specify):
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19.
Do you consent to the processing of your personal data?
(Required.)
I agree to the terms of personal data protection.