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