Date of birth
Type of Assessment
Laser
Cataract
Vitreolysis / Floater
Other (include in below other information)
Preferred Days
Monday
Tuesday
Wednesday
Friday
How Did You Find Us?*
Search Engines (Google, Bing, Yahoo)
Social media - Facebook, Instagram, Tiktok
From a friend/family member
From another doctor
Newsletter
Text message/SMS
Influencer (which one/ channel)
Radio (incl. Podcast)
AI Chats (ChatGPT, Gemini, Perplexity)
Other
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