Please check the required fields
Contact Tel number
Do you mind wearing glasses?
Do you own more than one pair of glasses?
If 'yes' what do you use them for?
Do you wear contact lenses?
If 'yes' how many hours per day are you on the computer?
Do you frequently drive at night?
If 'yes' do you notice halos or rings around lights?
How important is it for you to read or use the computer without glasses
How do you hold your book when reading
Close to your face
In your lap
Check the following activities you do on a regular basis
Read newspapers / books
Drive - Day time
Drive - Night time
Use mobile phone
Paint / Draw
Use the computer
Play musical instruments
Paperwork / Writing
Whick of the above wold you like to do without glasses if possible?
What occupational, recreational or other activities do you currently engage in that are not listed above?
How would your friends describe your personality?
Very easy going
Fairly easy going
Slightly easy going
Bit of a perfectionist
Fairly concerned with perfection
Please enter your last optical prescription if you have it (RE)
Please enter your last optical prescription if you have it (LE)
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