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Pre-Appointment Questionnaire

Please ensure you complete the questionnaire before your visit

Please take a minute to fill in our short health and lifestyle questionnaire ahead of your visit. It won't take long but will help us meet your needs during your appointment. The information you provide us with will be held securely and will only be used by your clinician to provide you with the best care.

All fields marked with * are mandatory

Personal details

Please complete this to allow us to find your details before your appointment

Date of birth*

In certain groups, the likelihood of certain eye diseases is higher. We ask for your ethnicity to allow us to provide the best possible clinical care for you.

Please enter 2 or more characters

Pre-Visit Questionnaire

What is the main reason for your appointment with us?*

You may be offered an enhanced eye examination which includes an OCT scan, which helps us to view the health of your eyes in greater detail, by allowing us to see what’s going on beneath the surface of the eye. Click to find out more.

Do you have any other vision or eye health concerns or headaches?*
Do you take any medications?*
Do you use computer, tablet and phone screens at all?*
Do you currently wear glasses?*
Are you a contact lens wearer?*

Find out more about how we use your information by visiting our online Privacy Policy. Your information will be sent securely to the clinicians in-store.

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