Skip to content

615-419-4250
|

Drs. Jeff and Susan Kegarise

About
The Book
Speaking
Media
Blog
Contact

Your Vision Made Clear By Cool Springs EyeCare

Eyecare Assessment

Don’t let blurry vision hold you back from enjoying the beauty of life to the fullest! Did you know it’s important to get a comprehensive eye exam yearly? Get started by taking this free eyecare assessment and book an appointment with one of Drs. Kegarises’ team members today!

Step 1 of 8

0%

1. When was the last time you had your eyes examined?*
- Within the last year
- 1-2 years ago
- 3 or more years ago
- I have never been to an Eye doctor in the last 10 years.

2. What is your age?*
- 18-35
- 35-50
- 50-70
- 70+

3. Do you regularly wear contacts or eyeglasses of any kind?*
- No
- Part Time
- Yes

4. Do you ever feel discomfort and/or irritation in your eyes?*
- No
- Yes, once in awhile
- Yes, often

5. Do you find yourself struggling to see things at a distance?*
- No, I can see distance objects (TV, driving, sporting events) well.
- Yes, sometimes I have difficulties, particularly during rainy or nighttime conditions .
- Yes, my distance vision is blurry.

6. Do you find yourself struggling to read print or cell phone text up close?*
- No, I don’t have trouble reading text up close.
- Yes, Sometimes I find myself pulling the text away when trying to read it.
- Yes, I have difficulty reading text up close.

7. Have you or a family member ever been diagnosed with Cataracts, Glaucoma or Macular Degeneration?*
- No
- Yes, someone in my family has received one of these diagnoses, but I have not.
- Yes, I have received one of these diagnoses, but I am the only one in my family with one of these diagnoses.
- Yes, both my family I have or had one of these diagnoses.

Name*
First Last
Email*
NOTE: By clicking the submit button, you are agreeing to receive email updates from Dr. Jeff Kegarise. You can unsubscribe at any time.
CAPTCHA
Please confirm you're not a robot.
Phone
This field is for validation purposes and should be left unchanged.

Contact us

Call us
Send us an email

About us

Home
About
The Book
Speaking
Media
Blog
Contact

Subscribe

Email*
CAPTCHA
Please confirm you're not a robot.

Social networks

Copyright 2024 Dr. Jeff Kegarise. Powered by Advantage Media Group.

Our site uses cookies to improve user experience. By continuing to use this site, you agree to our Policies.