Patient Feedback Survey

Patient Feedback Survey
THANK YOU for selecting NaturalVue® (etafilcon A) Brand Contact Lenses. We hope that you are enjoying them.

We value your opinion so that we can assess the quality of our products and work to continuously improve them. The survey should take you less than 5 minutes to complete.

You agree that Visioneering Technologies, Inc. (“VTI”) will own all right, title and interest to your responses to the survey, and that VTI may freely use your survey responses for any purpose, provided that VTI hereby agrees not to publicly disclose your individual survey responses except in an aggregated format with other survey responses in which responses are not identifiable to an individual respondent:*

I agreeI do not agree
Please select one:*

I acknowledge and represent that I am over the age of eighteen years and that I have read and understood this Release.I acknowledge and represent that the Subject is a minor and that I am the parent or Legal Guardian of the Subject and that I have the legal right and authority to execute this Release on behalf of the minor and that I have read and understood this Release.
Please select the country in which you live.*
MKT-NVU-EB12 r1

Please feel free to add any additional comments or share your experiences below:
Patient Information

Note: Your contact information is not required.
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Should be Empty:

Patient Information