YAG Capsulotomy Questionnaire

 
  • Please answer correctly the questions below before scheduling your cataract surgery. Please choose the best answer.
  • Visual Functioning
    Do you have difficulty, even with glasses, with the following activities?
  • Symptoms
  • *This form must be completed prior to each YAG Cap
  • Date Format: MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.

Copyright © [year] Eye Specialists of Delaware. All Rights Reserved.