Name *
Name
Phone
Phone
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Survey Questions
Take our seven question survey to see if ChromaGen™ can change your life! Once you complete the survey, we will be in touch with your results. We are collecting this information solely to help you or your child. We will not release your personal/contact information to any third party for marketing or advertising purposes.
Do you have double vision when reading or see two words or sentences? *
Do you notice words or sentences that are blurry or wiggly when reading? *
Do you see words or sentences that come in and out of focus when reading? *
Do the words "pop out"? *
Do the words ever "scrunch together" or "pull apart" when reading? *
Do the words move from side to side or up and down when reading? *
Do the words move, jump, swim, or appear to float on the page when reading? *
Is there anything else we need to know about?

ChromaGen™ lenses are a life changing aid for patients with visual reading disorders associated with Dyslexia, as well as an optical corrective solution for color deficiency commonly known as Color Blindness. ChromaGen™ has FDA clearance and is patented.