Date of Birth*
How long have you been wearing glasses?*
How often are you wearing your glasses?*
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?
What were your favorite features in previous eyeglasses?
Do you have any metal allergies?*
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!
All EyeCare Services
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