QUESTION 2:

HAVE YOU EVER BEEN TOLD YOU HAVE ASTIGMATISM?​​

QUESTION 3:

DO YOU HAVE TO WEAR GLASSES/CONTACTS FOR?

QUESTION 4:​​

HAVE YOU HAD ANY OF THE FOLLOWING PROCEDURES ON YOUR EYES (LASIK, PRK, RK, CATARACT SURGERY)?

QUESTION 5:​​

DO YOU SUFFER FROM MULTIPLE SCLEROSIS, LUPUS, KERATOCONUS OR DIABETIC RETINOPATHY?

QUESTION 6:

IF YOU WERE TO COME IN FOR A CONSULTATION, WHICH LOCATION WOULD WORK BEST FOR YOU?

QUESTION 7:

WHAT EMAIL SHOULD WE SEND THE RESULTS TO?

QUESTION 8:

WHAT IS YOUR FIRST NAME?

QUESTION 9:

WHAT IS YOUR LAST NAME?

QUESTION 10 (THE FINAL ONE!):

WHAT PHONE NUMBER CAN WE USE TO CALL/TEXT YOU?