Skip to content
310-444-1134
APPOINTMENT REQUEST
OD/MD Portal
About Us
BARRY S. SEIBEL, MD
Dr. Seibel’s Textbook
Dr. Seibel’s Inventions
Blog
Medical Consulting
Peer Testimonials
Patient Testimonials
Dr. Seibel’s Personal Philosophy
Dr. Seibel’s Curriculum Vitae
IN MEMORY OF JAMES SALZ, MD
Cataract Surgery
What is a Cataract
Cataract Symptoms
CATARACT SURGERY
Surgical Facility
Premium Lens Implants
JNJ Tecnis Odyssey
JNJ Tecnis TORIC II
JNJ Tecnis Symphony
JNJ Tecnis Monofocal
Alcon Vivity
Alcon Panoptix
Bausch & Lomb enVista Toric and Monofocal
Bausch & Lomb Crystalens
RxSight Light Adjustable Lens
Cataract FAQS
Cataract Self-Test
VISION CORRECTION
Refractive Lens Exchange
LASIK
WHAT IS LASIK?
LASIK Candidacy
LASIK Alternatives
PRK
Refractive Lens Exchange
LASIK FAQs
LASIK Financing
LASIK Cost
LASIK Insurance
PATIENT EDUCATION
About The Eye
Eye Conditions
Astigmatism
Blepharitis
Cataracts
Conjunctivitis
Diabetic Retinopathy
Dry Eye
Flashes & Floaters
Glaucoma
Hyperopia
Macular Degeneration
Myopia
Presbyopia
Pterygium
Stye/Chalazion
Eye Procedures
Cataract Surgery & Lens Implants
YAG Laser Capsulotomy
Refractive Lens Exchange
Laser Iridotomy
Limbal Relaxing Incisions
PHAKIC IOL
Punctal Occlusion For Dry Eyes
Laser Trabeculoplasty For Glaucoma
ISTENT For Glaucoma
Eye Exam
Optical Prescriptions
Educational Videos
FOR PATIENTS
Patient Information
Why Choose Us
HIPAA
Patient Forms
Payment Options
Physician Referrals
Disclaimer
Surgical Facilities
CONTACT
Contact Us
Appointments
Map & Directions
Menu
About Us
BARRY S. SEIBEL, MD
Dr. Seibel’s Textbook
Dr. Seibel’s Inventions
Blog
Medical Consulting
Peer Testimonials
Patient Testimonials
Dr. Seibel’s Personal Philosophy
Dr. Seibel’s Curriculum Vitae
IN MEMORY OF JAMES SALZ, MD
Cataract Surgery
What is a Cataract
Cataract Symptoms
CATARACT SURGERY
Surgical Facility
Premium Lens Implants
JNJ Tecnis Odyssey
JNJ Tecnis TORIC II
JNJ Tecnis Symphony
JNJ Tecnis Monofocal
Alcon Vivity
Alcon Panoptix
Bausch & Lomb enVista Toric and Monofocal
Bausch & Lomb Crystalens
RxSight Light Adjustable Lens
Cataract FAQS
Cataract Self-Test
VISION CORRECTION
Refractive Lens Exchange
LASIK
WHAT IS LASIK?
LASIK Candidacy
LASIK Alternatives
PRK
Refractive Lens Exchange
LASIK FAQs
LASIK Financing
LASIK Cost
LASIK Insurance
PATIENT EDUCATION
About The Eye
Eye Conditions
Astigmatism
Blepharitis
Cataracts
Conjunctivitis
Diabetic Retinopathy
Dry Eye
Flashes & Floaters
Glaucoma
Hyperopia
Macular Degeneration
Myopia
Presbyopia
Pterygium
Stye/Chalazion
Eye Procedures
Cataract Surgery & Lens Implants
YAG Laser Capsulotomy
Refractive Lens Exchange
Laser Iridotomy
Limbal Relaxing Incisions
PHAKIC IOL
Punctal Occlusion For Dry Eyes
Laser Trabeculoplasty For Glaucoma
ISTENT For Glaucoma
Eye Exam
Optical Prescriptions
Educational Videos
FOR PATIENTS
Patient Information
Why Choose Us
HIPAA
Patient Forms
Payment Options
Physician Referrals
Disclaimer
Surgical Facilities
CONTACT
Contact Us
Appointments
Map & Directions
Refractive Lens Exchange Self-Test
Home
»
Refractive Lens Exchange Self-Test
Refractive Lens Exchange Self-Test
Vision Correction Surgery Self-Test
Step
1
of
9
11%
First Name
(Required)
Last Name
(Required)
Phone
(Required)
Email
Can We Text You?
(Required)
Yes
No
What is your age group?
Under 18
19-39
40-59
60+
Without my glasses and contacts... (check all that apply)
Farsightedness: I have trouble reading and seeing things up close
Nearsightedness: I have trouble driving and seeing things far away
Astigmatism: I have distorted vision and cannot see very well
What do you usually wear? (check all that apply)
(Required)
Glasses
Contacts
Reading Glasses
None of Them
Do you have any of the following? (check all that apply)
(Required)
Rheumatoid Arthritis
Multiple Sclerosis
Lupus
Cataracts
Keratoconus
Diabetic Retinopathy
Prior Eye Surgery
Prior serious eye injury
Are you pregnant or nursing?
None of the above
I would like to see well at a distance without relying on glasses and contact lenses.
Rate this statement on a scale of 1 to 5 with 1 being the lowest.
(Required)
1
2
3
4
5
I would like to see well up close without relying on glasses and contact lenses.
Rate this statement on a scale of 1 to 5, with 1 being the lowest.
(Required)
1
2
3
4
5
Would your lifestyle improve if you were to become less dependent on glasses and contact lenses?
Would your lifestyle improve if you were to become less dependent on glasses and contact lenses?
(Required)
Yes
No
Would you like to speak with our Surgical Vision Correction Team?
I'm ready to book my consultation!
Yes, please call me to discuss my options.
I'm not ready yet
Verification