Pre-Visit Questionnaire

Before your consultation for an assessment please complete and email us this short Pre-Visit Questionnaire.

Contact Lenses should never be supplied without a detailed and extensive examination of the eyes carried out by a dedicated Contact Lens Specialist – not all Opticians are legally qualified to fit or supply contacts.

Therefore before we fit you with Contacts it is vital that we gain a full history of your eyes, your general health as well as your visual needs both at work and at play – all have a bearing on the final choice of lens design we advise most suitable for your individual clinical needs.

Please complete this form and email it to us before your initial Contact Lens Assessment to assist us compiling your record card. When most new patients visit they are surprised at the array of specialist equipment we utilise to gain the fullest details of your eyes and their shape etc.

You’ ll see what we mean if you click here to see the basic equipment in our instrument room!

In a SPECIALIST practice like ours you should allow at least 2 hours for your initial consultation.

Fields marked * are mandatory

      Personal information

      Contact Lens History

    • Approximately how long ago was your last eye test: years months ago.

      Health history

      • It is dangerous to fit lenses without full medical and ocular details. Very few conditions preclude fitting. Many suggest a specific lens material or type of fitting.

      To reassure you. Lots of 'ticks' do not mean you are unsuitable. A final decision is only possible after a tolerance trial.

      Please place a tick in the appropriate box should you at present, or in the past, have suffered with any of the following conditions. Should there be any other points which you think relevant, please add these at the bottom under "any other details".

      Further Information

    CONFIDENTIALITY

    All personal and clinical information is treated in strict confidence. No detail of your case history will be given to anyone except with your written permission.

    Please click on the following button to send this information to our staff.