Dry Eye Survey

Name(Required)
All of the timeMost of the timeHalfSome of the timeNone
Eyes that are sensitive to light?
Eyes that feel gritty?
Painful or sore eyes?
Blurred vision?
Poor Vision?
All of the timeMost of the timeHalfSome of the timeNone
Reading
Driving at night?
Working with a computer or bank machine (ATM)
Watching TV?
All of the timeMost of the timeHalfSome of the timeNone
Watching TV?
Places or areas with low humidity (i.e. very dry)
Areas that are air conditioned?
YesNo
Antihistamines (oral or eye drops)
Diuretics (water pill for hypertension)
Sleeping Pills
Hormone Replace Therapy
Oral Contraceptives
Tranquilizers
Beta-Blockers
Anti-depressants
Chemotherapy

Terms and Conditions (T&Cs):

  1. This offer exclusively applies to complete pair purchases (frames + lenses).
  2. The initial pair must be selected from our designer range and purchased at its full price.
  3. The cost of the first pair must equal or exceed the total cost of the second pair or the free buddy frame.
  4. This offer exclusively applies to frames and plano (or no prescription) sunglasses. Lens prices are not included in the discount.
  5. While this promotion is ongoing, management reserves the right to conclude the offer at its discretion.

Full Name(Required)
Home Address(Required)
(This is the practice you normally attend and would like to pick up your contact lenses)

Payment

If you selected to pick up in practice, you can arrange payment at time of pick up. If you selected to have your order delivered, we will contact you to arrange payment prior to dispatching your order.