YOUR INDIVIDUALIZED

VISUAL TREATMENT PLAN

To get started complete the form below so we can get to know you.

Your Eye Care Plan:

1) What is your occupation?
2) What are your favorite hobbies?
3) What sporting, recreational and/or outdoor activities do you enjoy?
4) How many hours per day are you on a computer?
5) Do you suffer from glare when driving at night?
6) Do you feel like you experience eye, neck, or head discomfort with computer use?
7) Do you feel like you have a droopy eyelid?
8) If you could change one thing about your glasses and/or contacts, what would it be?