{"id":6327,"date":"2019-03-06T05:31:08","date_gmt":"2019-03-06T05:31:08","guid":{"rendered":"https:\/\/staging.ciputrahospital.com\/lasik-relex-smile-quiz\/"},"modified":"2023-08-15T15:36:51","modified_gmt":"2023-08-15T08:36:51","slug":"lasik-relex-smile-quiz","status":"publish","type":"page","link":"https:\/\/ciputrasmgeyeclinic.com\/en\/lasik-relex-smile-quiz\/","title":{"rendered":"LASIK\/ReLEx\u00ae SMILE Quiz"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row content_placement=&#8221;middle&#8221;][vc_column width=&#8221;1\/6&#8243;][\/vc_column][vc_column width=&#8221;4\/6&#8243;][vc_custom_heading text=&#8221;Are You a Candidate for LASIK?&#8221; font_container=&#8221;tag:h1|font_size:40px|text_align:center|line_height:50px&#8221; use_theme_fonts=&#8221;yes&#8221; el_class=&#8221;heading-smgblue&#8221;][vc_custom_heading text=&#8221;Not all people can have LASIK. To find out if you are a good candidate for LASIK, answer these simple questions. Before performing LASIK surgery, you will also need to undergo a screening test at our clinic.&#8221; font_container=&#8221;tag:h2|font_size:30px|text_align:center|line_height:30px&#8221; use_theme_fonts=&#8221;yes&#8221; el_class=&#8221;heading-smgblue&#8221;][vc_separator][vc_custom_heading text=&#8221;If you are still unsure, take a web-based eye test to find out if you are eligible for the LASIK \/ ReLEx SMILE action&#8221; font_container=&#8221;tag:h1|font_size:30px|text_align:center|line_height:30px&#8221; use_theme_fonts=&#8221;yes&#8221; el_class=&#8221;heading-csecgreen&#8221;][vc_custom_heading text=&#8221;Answer the questions below to get started!&#8221; font_container=&#8221;tag:h1|font_size:35px|text_align:center|line_height:45px&#8221; use_theme_fonts=&#8221;yes&#8221; el_class=&#8221;jawab-text&#8221; css=&#8221;.vc_custom_1557304737939{margin-bottom: 50px !important;}&#8221;]\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f6330-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"6330\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en\/wp-json\/wp\/v2\/pages\/6327#wpcf7-f6330-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"6330\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f6330-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div class=\"fieldset-cf7mls-wrapper\"><fieldset class=\"fieldset-cf7mls\"><div style=\"text-align:center;\">\r\n<div class=\"quiz-questions\">How old are you?<\/div>\r\n    <div class=\"quiz-options\"><span class=\"wpcf7-form-control-wrap\" data-name=\"radio-625\"><span class=\"wpcf7-form-control wpcf7-radio\" id=\"userage\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-625\" value=\"Under 18\" \/><span class=\"wpcf7-list-item-label\">Under 18<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"radio-625\" value=\"18 - 39\" \/><span class=\"wpcf7-list-item-label\">18 - 39<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-625\" value=\"40 - 49\" \/><span class=\"wpcf7-list-item-label\">40 - 49<\/span><\/span><\/span><\/span><\/div>\r\n<\/div>\r\n\r\n<center class=\"btn-nav\"><button type=\"button\" class=\"cf7mls_next cf7mls_btn action-button\" name=\"cf7mls_next\">Next<\/button><\/fieldset><fieldset class=\"fieldset-cf7mls\"><\/center>\r\n\r\n<div style=\"text-align:center;\">\r\n<div class=\"quiz-questions\">What do you use most to help your eyesight?<\/div>\r\n     <div class=\"quiz-options\"><span class=\"wpcf7-form-control-wrap\" data-name=\"radio-626\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-626\" value=\"Glasses\" \/><span class=\"wpcf7-list-item-label\">Glasses<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"radio-626\" value=\"Contact Lenses\" \/><span class=\"wpcf7-list-item-label\">Contact Lenses<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-626\" value=\"None\" \/><span class=\"wpcf7-list-item-label\">None<\/span><\/span><\/span><\/span><\/div>\r\n<\/div>\r\n\r\n<center class=\"btn-nav\"><button type=\"button\" class=\"cf7mls_back action-button\" name=\"cf7mls_back\">Back<\/button><button type=\"button\" class=\"cf7mls_next cf7mls_btn action-button\" name=\"cf7mls_next\">Next<\/button><\/fieldset><fieldset class=\"fieldset-cf7mls\"><\/center>\r\n\r\n<div style=\"text-align:center;\">\r\n<div class=\"quiz-questions\">How often do you wear your glasses?<\/div>\r\n     <div class=\"quiz-options\"><span class=\"wpcf7-form-control-wrap\" data-name=\"radio-627\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-627\" value=\"Always\" \/><span class=\"wpcf7-list-item-label\">Always<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-627\" value=\"Sometimes\" \/><span class=\"wpcf7-list-item-label\">Sometimes<\/span><\/span><\/span><\/span><\/div>\r\n<\/div>\r\n\r\n<center class=\"btn-nav\"><button type=\"button\" class=\"cf7mls_back action-button\" name=\"cf7mls_back\">Back<\/button><button type=\"button\" class=\"cf7mls_next cf7mls_btn action-button\" name=\"cf7mls_next\">Next<\/button><\/fieldset><fieldset class=\"fieldset-cf7mls\"><\/center>\r\n\r\n<div style=\"text-align:center;\">\r\n<div class=\"quiz-questions\">Do the glasses get in the way of your daily activities, like sports, reading, working?<\/div>\r\n     <div class=\"quiz-options\"><span class=\"wpcf7-form-control-wrap\" data-name=\"radio-628\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-628\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-628\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span><\/div>\r\n<\/div>\r\n\r\n<center class=\"btn-nav\"><button type=\"button\" class=\"cf7mls_back action-button\" name=\"cf7mls_back\">Back<\/button><button type=\"button\" class=\"cf7mls_next cf7mls_btn action-button\" name=\"cf7mls_next\">Next<\/button><\/fieldset><fieldset class=\"fieldset-cf7mls\"><\/center>\r\n\r\n<div style=\"text-align:center;\">\r\n<div class=\"quiz-questions\">Have you ever felt dry eyes because of your contact lenses?<\/div>\r\n     <div class=\"quiz-options\"><span class=\"wpcf7-form-control-wrap\" data-name=\"radio-629\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-629\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-629\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/span><\/span><\/span><\/div>\r\n<\/div>\r\n\r\n<center class=\"btn-nav\"><button type=\"button\" class=\"cf7mls_back action-button\" name=\"cf7mls_back\">Back<\/button><button type=\"button\" class=\"cf7mls_next cf7mls_btn action-button\" name=\"cf7mls_next\">Next<\/button><\/fieldset><fieldset class=\"fieldset-cf7mls\"><\/center>\r\n\r\n<div style=\"text-align:center;\">\r\n<div class=\"quiz-questions\">Without glasses or contact lenses, are you having trouble seeing far or near?<\/div>\r\n     <div class=\"quiz-options\"><span class=\"wpcf7-form-control-wrap\" data-name=\"radio-630\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-630\" value=\"Trouble Seeing Far\" \/><span class=\"wpcf7-list-item-label\">Trouble Seeing Far<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"radio-630\" value=\"Trouble Seeing Near\" \/><span class=\"wpcf7-list-item-label\">Trouble Seeing Near<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"radio-630\" value=\"Trouble Seeing Both Far &amp; Near\" \/><span class=\"wpcf7-list-item-label\">Trouble Seeing Both Far &amp; Near<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-630\" value=\"None\" \/><span class=\"wpcf7-list-item-label\">None<\/span><\/span><\/span><\/span><\/div>\r\n<\/div>\r\n\r\n<center class=\"btn-nav\"><button type=\"button\" class=\"cf7mls_back action-button\" name=\"cf7mls_back\">Back<\/button><button type=\"button\" class=\"cf7mls_next cf7mls_btn action-button\" name=\"cf7mls_next\">Next<\/button><\/fieldset><fieldset class=\"fieldset-cf7mls\"><\/center>\r\n\r\n<div style=\"text-align:center;\">\r\n<h2 style=\"margin-bottom:50px;\">Fill in the data below to find out the results<\/h2>\r\n<div class=\"quiz-questions label\">Name<\/div>\r\n    <div class=\"quiz-info\"><span class=\"wpcf7-form-control-wrap\" data-name=\"firstname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"firstname\" \/><\/span><\/div>\r\n\r\n<div class=\"quiz-questions label\">Email<\/div>\r\n    <div class=\"quiz-info\"><span class=\"wpcf7-form-control-wrap\" data-name=\"email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"email\" \/><\/span><\/div>\r\n\r\n<div class=\"quiz-questions label\">HP Number<\/div>\r\n    <div class=\"quiz-info\"><span class=\"wpcf7-form-control-wrap\" data-name=\"contact\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"contact\" \/><\/span><\/div>\r\n\r\n<input class=\"wpcf7-form-control wpcf7-hidden\" value=\"quiz\" type=\"hidden\" name=\"text\" \/>\r\n<input class=\"wpcf7-form-control wpcf7-hidden\" value=\"\" type=\"hidden\" name=\"utm_campaign\" \/>\r\n<input class=\"wpcf7-form-control wpcf7-hidden\" value=\"\" type=\"hidden\" name=\"utm_source\" \/>\r\n<input class=\"wpcf7-form-control wpcf7-hidden\" value=\"\" type=\"hidden\" name=\"utm_term\" \/>\r\n<input class=\"wpcf7-form-control wpcf7-hidden\" value=\"\" type=\"hidden\" name=\"utm_medium\" \/>\r\n<input class=\"wpcf7-form-control wpcf7-hidden\" value=\"\" type=\"hidden\" name=\"utm_content\" \/>\r\n<input class=\"wpcf7-form-control wpcf7-hidden\" value=\"\" type=\"hidden\" name=\"gclid\" \/>\r\n<input class=\"wpcf7-form-control wpcf7-hidden\" value=\"\" type=\"hidden\" name=\"handl_original_ref\" \/>\r\n<input class=\"wpcf7-form-control wpcf7-hidden\" value=\"\" type=\"hidden\" name=\"handl_landing_page\" \/>\r\n<input class=\"wpcf7-form-control wpcf7-hidden\" value=\"\" type=\"hidden\" name=\"handl_ip\" \/>\r\n<input class=\"wpcf7-form-control wpcf7-hidden\" value=\"\" type=\"hidden\" name=\"handl_ref\" \/>\r\n<input class=\"wpcf7-form-control wpcf7-hidden\" value=\"\" type=\"hidden\" name=\"handl_url\" \/>\r\n<input class=\"wpcf7-form-control wpcf7-hidden\" value=\"\" type=\"hidden\" name=\"qualify\" \/>\r\n\r\n<center><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"SEE RESULT\" \/><\/center>\r\n<\/div><input type=\"button\" value=\"Back\" style=\"\" class=\"cf7mls_back action-button\" name=\"cf7mls_back\"><\/fieldset><\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n[vc_empty_space height=&#8221;60px&#8221;][\/vc_column][vc_column width=&#8221;1\/6&#8243;][\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row content_placement=&#8221;middle&#8221;][vc_column width=&#8221;1\/6&#8243;][\/vc_column][vc_column width=&#8221;4\/6&#8243;][vc_custom_heading text=&#8221;Are You a Candidate for LASIK?&#8221; font_container=&#8221;tag:h1|font_size:40px|text_align:center|line_height:50px&#8221; use_theme_fonts=&#8221;yes&#8221; el_class=&#8221;heading-smgblue&#8221;][vc_custom_heading text=&#8221;Not all people can have LASIK. To find out if you are a good candidate for LASIK, answer these simple questions. Before performing LASIK surgery, you will also need to undergo a screening test at our clinic.&#8221; font_container=&#8221;tag:h2|font_size:30px|text_align:center|line_height:30px&#8221; use_theme_fonts=&#8221;yes&#8221; el_class=&#8221;heading-smgblue&#8221;][vc_separator][vc_custom_heading text=&#8221;If you [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","_lmt_disableupdate":"yes","_lmt_disable":"","footnotes":""},"class_list":["post-6327","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>LASIK ReLEx Smile Quiz - Ciputra SMG Eye Clinic<\/title>\n<meta name=\"description\" content=\"Take the Ciputra SMG Eye Clinic LASIK ReLEx Smile Quiz to find out if you are a good candidate for LASIK. 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