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* 1. Whenever we are told it's safe to reopen after lockdown, for non urgent care which we're still offering, how would you feel about getting your eyes examined? (Assuming all measures are taken for hygiene, distancing and protection)

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* 2. Are you currently having any issues with your eyes that you feel aren't urgent but that you'd like checking when it's considered safe to do so?

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* 3. When was your last eye examination?

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* 4. Assuming you've had an eye examination before what sort of business looked after your eyes at your last check up and would you consider changing given everything that's gone on with COVID-19?

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* 5. What age group do you fit in to?

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* 6. Are you in one of the high-risk groups for COVID-19? (Pregnant, pre-existing medical conditions, 70+, immunocompromised etc)

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* 7. Would you like us (Maskell and Josephson) to contact you with any information about what services we're currently offering, what we're doing to protect our patients when we reopen after lockdown and/or contact you to arrange an appointment when it's safe to do so? If you're happy for us to contact you please leave contact details in the box below.

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