Electric Eyesight - Start

Welcome! 

Thank you for being a part of the Electric Eyesight with Stacey research study and beta group! We’re so excited to have you here and excited to see where this research leads. Please complete all questions in this survey and be sure you understand what’s required for the class to work as a research study. 

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Full Name

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Age *

What drew you to join this class? 

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Any particular goals in mind?

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Do you wear glasses? 

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Do you wear contacts? 

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Do you know your prescription? 

It would be great to find out what your prescription is before the class if possible!

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Enter your prescription here if you know it. 

Do you have any diagnosed eye condition(s)? If so, please list conditions and if you've had any treatments related to those conditions. 

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Are you willing and able to attend the class each week?

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Are you willing and able to watch each week’s group tuning a second time before the next class? 

(The group tuning portion of the class will be recorded and available in audio format and video format) 

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Are you willing and able to obtain the Sonic Slider tuning fork? 

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Are you willing and able to use the Sonic Slider tuning fork daily? 

(Stacey will teach you how to do this in about 10-15 minutes a day - you’re more than welcome to use it for longer if you like) 

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