Understanding Your Lifestyle
Please print this page, fill in your information and bring it with you on your next visit.

How many pairs of perscription Glasses do you currently use?_________________________

How do you use your eyes at work?_______________________
Do you work outdoors?________
At a computer?________
Close detailed work?________
Are you around any hazards?________

What type of glasses do you wear when you are driving:
during the day?________
at night?________

Are you bothered by bright sunlight?________

Are you bothered by glare?________

What do you like most about your current glasses?___________________________________
______________________________________________________________________
and the least?_______________________________________________________________

List your primary hobbies or recreational sports you enjoy: