Medical History
First Name *
Your answer
Last Name *
Your answer
Currently Wear: *
If you wear contacts, what brand of lenses do you wear? Please put your contact lens prescription here if you know that too.
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Are you interested in contact lenses?
What special vision needs or hobbies do you have?
Your answer
How many hours a day do you spend on a computer, tablet, or smartphone?
Your answer
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