Lens Checklist

Your doctor and dispensary staff will help you choose the lens material and options that best meet your needs. The checklist below will help you provide the office staff with helpful information in determining the appropriate lenses and treatments for you.

I will wear these glasses:
__ Full-time
__ Part-time
__ For reading or close work only

I will perform the following activities while wearing my glasses: (check all that apply)
__ Driving (daytime)
__ Driving (nighttime)
__ Playing sports
__ Using a computer for several hours at a time
__ Outdoor activities

I wear:
__ Single vision glasses
__ Bifocals
__ Trifocals
__ Don't know

I am nearsighted and/or would like thinner lenses.
__ Yes
__ No

I would like sun protection included on my glasses.
__ Yes
__ No

I expect this pair of glasses to last for:
__ One year
__ Two years
__ Three or more years

I own (or plan to own) more than one pair of glasses in my current prescription:
__ Yes
__ No

I plan to purchase an extra pair of glasses or prescription sunglasses:
__ Yes
__ No

 

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Mon-Sat 7:30AM to 11:00PM ET
Sun 11:00AM to 8:00PM ET

 



 


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