Eye Care Questionnaire

To be completed only after confirming your appointment

As part of your normal eye examination, we usually ask you a series of questions about your health, any vision issues and how you use your spectacles or contact lenses. To help speed up the process and reduce the time you need to spend in the practice for your appointment, we have created an online questionnaire.

We would kindly ask that you complete the questionnaire as accurately and fully as possible and submit it to us in advance of your appointment. You are not required to enter any personal information if you do not feel comfortable doing so. The only required information is the patient name, the COVID screening section and the practice the appointment is with.

If you are completing the questionnaire on behalf of someone else, please check the answers with that person before submitting it. The responses should relate to the person who has the appointment with us.

Thank you.

Stay at home NHS