Self Evaluation Test Name* First Last Phone*Email* Do you have trouble seeing far away or up close?*Up CloseFar AwayHow interested are you in being able to play sports without glasses or contacts?*It is VERY important to me. I hate wearing my glasses/contacts during sports.I don't mind. It doesn't bother me to wear my glasses/contacts during sports.What is your age?*Under 2121-4040-6969+Are you interested in seeing up close (reading) without glasses?*It is VERY important to me not to wear glasses for up close.It's not important to me. I don't mind wearing glasses for up close reading.Do you wear glasses or contacts currently?*GlassesContactsBoth This iframe contains the logic required to handle Ajax powered Gravity Forms.