Kelly Eye Center Lifestyle Lens Post-Surgery Survey Question Title * 1. How would you rate your distance vision? Poor Disappointing Neutral Good Excellent Poor Disappointing Neutral Good Excellent OK Question Title * 2. How would you rate your near (reading) vision? Poor Disappointing Neutral Good Excellent Poor Disappointing Neutral Good Excellent OK Question Title * 3. How would you rate your intermediate (arms-length / computer) vision? Poor Disappointing Neutral Good Excellent Poor Disappointing Neutral Good Excellent OK Question Title * 4. How would you rate your night vision? Poor Disappointing Neutral Good Excellent Poor Disappointing Neutral Good Excellent OK Question Title * 5. Do you ever wear glasses? Yes No OK Question Title * 6. If you wear glasses, when do you wear glasses? Distance vision activities (example: driving, watching TV or movies, sports) Intermediate vision activities (example: computer, cooking, email, gardening) Near vision activities (example: reading, sewing, cellphone use, applying makeup, knitting) OK Question Title * 7. If you had to do it again, would you make the same lens choice for your eyes? Yes No OK Question Title * 8. How would you rate your overall experience with Kelly Eye Center? Poor Disappointing Neutral Good Excellent Poor Disappointing Neutral Good Excellent OK Question Title * 9. Your Name and Additional comments: OK DONE