Eyewear Lifestyle Questionnaire

Eyewear Lifestyle Questionnaire

Eyeglasses are not only important for improving visual needs, but they are a fashion item and a reflection of your unique style and personality. Please answer a few questions so we can best assist you in finding the perfect frame and lens options to meet your optical needs!
Name

PrefixFirst NameLast NameSuffix
Date of Birth

MonthDayYear
Date
Email
example@example.com
How long have you been wearing glasses
Contact Lenses?
How often are you wearing your glasses?
Contact Lenses?
Do you have sunglasses; either prescription or non-prescription?
What is your occupation?
Please indicate any activity that you do regularly:
Are there any sports or hobbies you participate in? Please describe.
What were your favorite features in previous eyeglasses?
Do you have any metal allergies?

Other
Do you have a material preference for your frames?
Is there a color or style you are looking for?
Thank you so much for completing this form! We look forward to helping you find your next pair of eyewear!
Should be Empty: