Am I Suitable Questionnaire?

1. Do you have trouble seeing far away or up close without an optical aid?

2. What optical aid do you use for correcting your vision currently ?

prolonged optical away

3. What is your age?

4. Are you interested in seeing well up close (reading) without glasses?

It's very important to me NOT to wear reading glasses.
It's not important to me. I do not mind wearing reading glasses to see things up close.

5. To understand your visual needs, could you please tell us your occupation

6. Do you know your approximate visual prescription?

7. Do you have astigmatism?

8. Has your prescription been stable over the last two years?

9. Do your eyes hurt after prolonged eyewear use?

10. Medical conditions, medications & comments

Name

First

Last

Email

Contact Number

Subscribe for our Quarterly Newsletter