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?*

YesNo
What is your occupation?*
Please indicate any activity that you do regularly:

Read for long periods of timeWork on a computerWork with small objectsNight driving
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?*

YesNoOther
Do you have a material preference for your frames?*

MetalPlasticComboRimlessGrooved RimlessNo Preference
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!
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