selftest-portland-facebook.myk2vision.com
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2606:4700::6811:deda
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Submitted URL: https://selftest-portland-facebook.myk2vision.com/
Effective URL: https://selftest-portland-facebook.myk2vision.com/?cookieUUID=7a68c043-439c-4ba4-b1a9-faf67e7567b1&affiliate=0
Submission: On October 13 via automatic, source certstream-suspicious — Scanned from DE
Effective URL: https://selftest-portland-facebook.myk2vision.com/?cookieUUID=7a68c043-439c-4ba4-b1a9-faf67e7567b1&affiliate=0
Submission: On October 13 via automatic, source certstream-suspicious — Scanned from DE
Form analysis
10 forms found in the DOM#
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Text Content
WELCOME TO YOUR VISION SELF TEST TO START PLEASE TELL US HOW OLD YOU ARE Under 18 19-39 40-55 56+ Call to action QUESTION 2: HAVE YOU EVER BEEN TOLD YOU HAVE ASTIGMATISM? Yes No Call to action QUESTION 3: DO YOU HAVE TO WEAR GLASSES/CONTACTS FOR? Driving Computer Reading All of the above Call to action QUESTION 4: HAVE YOU HAD ANY OF THE FOLLOWING PROCEDURES ON YOUR EYES (LASIK, PRK, RK, CATARACT SURGERY)? Yes No Call to action QUESTION 5: DO YOU SUFFER FROM MULTIPLE SCLEROSIS, LUPUS, KERATOCONUS OR DIABETIC RETINOPATHY? Yes No Call to action QUESTION 6: IF YOU WERE TO COME IN FOR A CONSULTATION, WHICH LOCATION WOULD WORK BEST FOR YOU? Please Choose A Location Please Choose A Location KennewickVancouverLynnwoodTacomaTigardTukwilaScottsdale Call to action QUESTION 7: WHAT EMAIL SHOULD WE SEND THE RESULTS TO? Next QUESTION 8: WHAT IS YOUR FIRST NAME? Next QUESTION 9: WHAT IS YOUR LAST NAME? Last Name Next QUESTION 10 (THE FINAL ONE!): WHAT PHONE NUMBER CAN WE USE TO CALL/TEXT YOU? Phone Submit We use cookies and other similar technologies to improve your browsing experience and the functionality of our site. By clicking "Accept All Cookies," you consent to the storing on your device of all the technologies described in our Cookie Policy. You can revoke your cookie attestation by clearing your browser session and clicking "Dismiss". Accept All Cookies Dismiss TIME LIMIT REACHED Back to Page Question 1 of 10 Unfortunately you are not a candidate for RLE or ICL due to your age (18 or under). If you entered this age by mistake, refresh the page and select your age again. Unfortunately you are not a candidate for RLE or ICL due to having one of the pre-existing medical conditions that were listed. If you entered that you have one of those pre-existing conditions by mistake, refresh the page and select your choice again.