Welcome Questionnaire.

It would help us if you can complete this Questionnaire once before your appointment. The questionnaire is meant for new patients and recalled patients we haven't seen for a while and it is optional. Your answers will be referred to by the Optometrist during your eye examination and kept on your file. We look forward to seeing you then.

Question Title

* 1. Please type in your name and email address for your file.

Question Title

* 2. Are there any eye conditions in your immediate family

Question Title

* 3. If new to the practice when was the last time you had your eyes examined?

Question Title

* 4. Do you currently wear eye wear for different tasks? You can select more than one option. Please bring them along to the examination. ( * = available as a 2nd pair from $299)

Question Title

* 5. Do you have any recent health issues?

Question Title

* 6. Where do you work or study? Also how far away in cm are your digital devices from your eyes?

Question Title

* 7. What sports, interests or hobbies do you enjoy?

Question Title

* 8. If you wear glasses do you have sun protection?

Question Title

* 9. Are you interested in Contact Lenses? They are now available for children and for people wearing progressives.

Question Title

* 10. What helped you decide to make this appointment?

T