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Pre-Appointment Questions
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1. Are you an existing patient?
2. Have you had a previous eye test?
If yes, when was it?
3. Main reason for visit?
4. Are you a current spectacle wearer?
If yes, how old are they?
If yes, what are your current spectacles used for?
5. Do your spectacles need updating?
If yes, what is the reason for you update?
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6. Do you have any previous eye health history?
If yes, please select from the following
7. Is there any family eye health history?
If yes, please select from the following
8. How is your general health?
9. Are you on any prescribed medication?
If yes, please list the medication here:
10. What is you family general health like?
11. Do you have any allergies?
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12. What is your current occupation?
13. Please list your main hobbies and interests
14. Are you a contact lens wearer?
If yes, on average how many hours do you wear your contact lens in a day?
15. Do you drive?
If yes, on average how many hours do you drive in a day?
16. Do you use a computer screen?
If yes, on average how many hours do you use a computer screen in a day?
17. Do you need to update frames?
If yes, why?
18. Do you need to update lenses?
If yes, why?
Comments
Thanks, we'll be in touch soon
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