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Pre-Appointment Questions
Before we start
Can you please confirm your:
Anchor 1
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Are you an existing patient?
Are you a current spectacle wearer?
If yes, how old are they?
Why we need
this information
We need to know the following information so that we can update your clinical records on our system with your most up to date and accurate information.
Section 1
Why we are asking
Have you had a previous eye test?
If yes, when was it?
If yes, what are your current spectacles used for?
Main reason for visit?
Do your spectacles need updating?
If yes, what is the reason for your update?
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Do you have any previous eye health history?
If yes, please select from the following
Is there any family eye health history?
If yes, please select from the following
How is your general health?
Are you on any prescribed medication?
If yes, please list the medication here:
What is your family's general health like?
Do you have any allergies?
Why we need
this information
Section 2
Why we are asking
we need to be advised by you of your current clinical history so that we can best serve your needs during your visit.
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What is your current occupation?
Please list your main hobbies and interests
Are you a contact lens wearer?
If yes, on average how many hours do you wear your contact lenses in a day?
Do you use a computer screen?
If yes, on average how many hours do you use a computer screen in a day?
Do you need to update your frames?
If yes, why?
Why we need this information
Section 3
Why we are asking
This information will help us personalise your eyecare and eyewear needs following your examination.
Do you drive?
If yes, on average how many hours do you drive in a day?
Do you need to update your spectacle lenses?
If yes, why?
Comments
Thanks, we'll be in touch soon
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