Self test new – Brinton Vision – Lasik St. Louis

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Vision starting point

👓

Start with what you rely on every day.

Your current correction gives the team context for the rest of your answers.

✓ This helps personalize the distance and near-vision questions.

→ The quiz language adapts based on your answer.

Question 1 of 11 9%

Step 1

I most often wear

Choose the option that best describes what you rely on most often.

👓 glasses ◎ contacts 🔍 readers ✓ none of these

Please select an answer to continue.

Step 2

What is your age range?

This helps guide the conversation around which vision correction options may be worth discussing.

1 15-44 2 45-55 3 56-106

Please select an answer to continue.

Step 3

Without my glasses I have trouble reading street signs

Tell us how your distance vision feels in everyday life.

✓ yes – no

Please select an answer to continue.

Step 4

I've been told I have astigmatism

Astigmatism is common and helpful for our team to know about.

✓ yes – no

LASIK can now correct astigmatism!

Please select an answer to continue.

Step 5

Without my glasses I have trouble reading my cell phone

This helps us understand whether near vision is part of your daily frustration.

✓ yes – no

Please select an answer to continue.

Step 6

How well do you see at night?

Night vision is one reason a detailed diagnostic exam matters.

☾ very well ◐ ok, but could do better ! quite poorly

Please select an answer to continue.

Step 7

When choosing your vision correction surgeon, which factors matter most to you?

Select all that apply.

★ experience of the surgeon ⌁ technology 🛡 safety $ affordability → convenience

Please select at least one answer to continue.

Step 8

Would your life improve if you were less dependent on glasses and contacts?

Think about work, driving, travel, exercise, mornings, and everyday convenience.

✓ absolutely! ? maybe – not really

Clear eyesight, every waking moment, makes people more active and healthy!

Please select an answer to continue.

Step 9

If you are a candidate, when would you like to have your procedure?

This helps our team understand your timing and urgency.

1 ASAP 2 next few months 3 More than three months out

Most LASIK patients return to work the next morning!

Please select an answer to continue.

Your Preview Results

Your self-test suggests a vision correction conversation may be worthwhile.

Based on your answers, the next best step is a Brinton Vision Ocular Analysis.

This self-test does not diagnose candidacy or select a procedure. It simply helps guide the conversation before a full diagnostic exam.

Final Step

Send your results to our team.

Complete your contact information below. You will not need to retake the self-test. Your answers and preview result will be submitted with this form.

First name*

Last name*

Phone*

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