Williamson Allemond Regional Eye Center - FREE SURVEY

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Please complete this free survey to find out if you are a candidate for Multi-focal Intra-Ocular Lenses (IOL's). This information will be needed when you come in to see one of our Ophthalmologists.

First Name*
Last name
Email
Phone Number*
Address
City
State
Zip code
Comments
Would you like to see objects up close without the use of glasses after your cataract surgery? (An example of this would be reading a book or newspaper.)
Would you like to be able to see objects at a distance without glasses after your cataract surgery?
Please mark the statement that best describes you in terms of night vision.
If you had to wear glasses after surgery for one activity which activity below would you be most willing to use glasses?
If you could have good Distance Vision during the day without glasses and good Near Vision for reading without glasses but the compromise was that you might see some halos or rings around lights at night would you like that option?
If you could have good Distance Vision during the day and night without glasses and good Mid-range Vision without glasses but the compromise was that you might need glasses for reading the finest print at near would you like that option?
Surgery to reduce or eliminate your dependence upon glasses for Distance Mid-range and Near Vision may be partially covered by insurance if you have a cataract that is covered by insurance. Would you be interested in learning more about this options?
On a scale from 1 to 10 1 being "Easy Going" and 10 being "Perfectionist" write in a number that best describes your personality.*
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Links

Our Surgery Center

Outpatient Surgery & Cosmetic Center

6550 Main Street Suite 2600

Zachary, LA 70791

Office 225.570.6357

Fax 225.570.2237

Zachary Location

2421 Church Street

Zachary, LA 70791

Office 225.654.1061

Fax 225.654.0791

Port Allen Location

4263 LA Hwy 1 South

Port Allen, LA 70767

Office 225.308.6311

Fax 225.490-4969

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