Questionnaire for the pre-procedure Flow 2.0 Eye Examination

1.Full name:(Required.)
2.Age:(Required.)
3.Personal code:(Required.)
4.What's your current glasses prescription?(Required.)
5.What kind of vision aids do you use?(Required.)
6.How much are you disturbed by glasses and contact lenses in your daily life?(Required.)
7.What are the situations where glasses and contact lenses bother you most? (You may choose multiple answers)(Required.)
8.How long have you been considering a laser procedure?(Required.)
9.Why have you not had a laser eye procedure earlier?(Required.)
10.What motivated you to come to the eye examination?(Required.)
11.What most influences your decision on choosing an eye clinic for your procedure? (You may choose multiple answers)(Required.)
12.If you had the opportunity to undergo the procedure tomorrow, would you have any doubts or questions?(Required.)
13.Would your life quality improve without having to wear glasses and/or contact lenses?(Required.)
14.Do you have a person to discuss the final decision to undergo the laser procedure?(Required.)
15.Do you have any friends who have had laser treatment?(Required.)
16.What is most important to you when choosing a laser procedure?(Required.)
17.If you qualify for the procedure, how soon would you plan to schedule?(Required.)
18.How did you hear about KSA Vision Clinic?
19.Do you consent to the processing of your personal data?(Required.)