Pre-Appointment Questions  

1a.   Are you an existing patient? 

1b.   Main reason for visit


7a.   Are you a driver? 

7b.   How many hours a day

8a.   Are you a smoker?

2a.   How is your general health? 

9a.   Are you a contact lenses wear?

3a.   Previous ocular history

9b.   How many hours a day

4a.   Family History 

5a.  Current spectacle wearer?

10a.   List hobbies 

11a.   Are you currently taking any prescribed medication? 

5b.   Currently used for


11b.   Please list

5c.  Do they need updating? 

5d.  Reason for update 

6a.   VDU user? 

12a.   Current occupation 

13a.   Are you looking to update your frames? 

13b.   Looking for something similar or different? 

14a.   Are you looking to update your spectacle lenses

6b.   How many hours a day

14b.   Reason to update your spectacle lenses

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