Inlay Suitability Check If you’re frustrated with your reading glasses and are looking for a long-lasting solution to near vision loss, it’s time to learn about the inlay treatments offered by Beach Eye Care. We invite you to find out if you may be a suitable candidate. Take a moment to answer a few brief questions below. Just 5 questions to see if you are eligible!1. Have you had any of the following eye procedures?I haven’t had eye proceduresLaser vision correctionCKCataract surgeryOtherOther2. Which statement best describes your need for glasses or contact lenses?I need them to see well at all distances (near, far and in between)I need them only when I am performing a near task such as reading a newspaperI need them only when I’m working on my computerI need them to see street signsOtherOther3. How often do you wear reading glasses to see near objects clearly?FrequentlyOccasionallyRarelyNever4. Considering your professional life, please check the one activity you do most often:TalkingComputerReadingDrivingPhysical activityOtherOther5. What are you most interested in at this time?I’d like to reserve a seat at a patient seminar to learn moreI’d like to schedule an inlay consultationI’d like to have someone call mePlease add me to your mailing listOtherOtherYour DetailsName* First Last Email* Daytime PhoneYour Age*Under 45Between 45 – 50Between 51 – 65Over 65Best time to contact you*MorningAfternoonEvening This iframe contains the logic required to handle AJAX powered Gravity Forms.