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Email *
What is your first & last name? *
What is the best number to reach you at? *
What city and state do you live in? *
Do you give permission to our team to text you if necessary? (Msg & data rates may apply) *
What is your age? *
Do you have normal vision (e.g., to shop a store shelf without needing corrective lenses)? (Select one) *

On the day of your appointment, you must come wearing your contact lenses. If you do not come wearing your contact lenses, you may not be eligible to participate in this 

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