Please complete this survey online so we can have your file ready as soon as you arrive for your appointment.
Your Name (required)
Date of Birth (required)
Home Ph. No
Work Ph. No
Email Address (required)
Have you had your eyes examined in the last two years?
Covered Optical Benefits?
Do you have any special visual needs for your hobbies or sports?
How long would you use a computer for each day?
Would you like to learn more about or trial some contact lenses?
Do you need Prescription Sunglasses?
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