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Multi-Step Form with AJAX
Are you a candidate for Laser Vision Correction?
Take this short survey to find out!
Please Enter your Personal Details.
Select your Age Bracket
18-25 Years
25-35 Years
35-45 Years
45 & above
Are your specs stopping you from living life to the fullest?
Yes
No
Do you wear glasses?
Glasses
Lenses
Both
What troubles you more?
Seeing far away objects
Seeing nearby objects
Are you thinking of saying goodbye to your eyeglasses or contacts?
Yes 😀
Still Doubtful