Individual Assessment Individual Assessment These questions will help us to understand your vision needs better. Name*FirstLastEmailWhat prompted today's visit? Vision difficulty while...DrivingReadingAt the computerWatching televisionAnnual examOther (please specify in notes section)When do you need your glasses to help you?Seeing up closeSeeing far awayI need both regularlyAt the computerHow often do you wear your glasses?Rarely (1-3 times per week)Sometimes (1-3 times per day)Often (a few hours a day)Constantly (apart from sleeping)What concerns do you have with your sight at work?Computer useKeyboard useMonitor glareOther (please specify in notes section)Do you have vision issues while participating in the following activities?DrivingWorking with my hands/arts and craftsComputer/office workReadingWatching televisionCookingManual work conditionsHiking/going for a walkSportsWatching live events (theater, ball games, etc)Other (please specify in notes section)Check all the boxes below that apply to you:Problems seeing at nightSeeing blurry car headlightsSensitivity to lightFrequent cleaning of your eye glassesScratched lenses (glasses)Glasses often slip down your noseProblems with peripheral visionEyes feeling tired or strainedProblems focusing at the computerObjects are not as sharp and crispEyes burning or stingingPressure marks on your noseNotes: Sight is the most important of our senses. Our eyes show us life in all of its glory. The first step, is to completely understand your eyes. Before we measure anything, we establish your visual habits and needs. This allows us to determine exactly what your new lenses should be.Real Person Verification Share this:ShareRedditPrint