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YOUR ANSWERS, PLEASE!

We are always interested in your experiences as a glaucoma patient or glaucoma suspect, or as a family member, caregiver or friend of a patient. So, from time to time we will ask you a few simple questions on such subjects as awareness, compliance, counsel from physicians, etc. Your answers will help us carry forward our educational initiatives.

	1. I am a glaucoma patient: Yes No
	2. I am a glaucoma suspect: Yes No
	3. I do not have glaucoma: True False
	4. My age is: under 40 41 - 50 51 - 60 over 61
	5. How did you first learn about the need to get tested for glaucoma? General Physician Family Member Friend Other If other, please specify:
	6. Does your general physician discuss eye care with you? Yes No
	7. Has your general physician reminded you to get your eyes examined? Yes No

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