Lifestyle Questionnaire | The Optical Experience

The Optical Experience

Client Intake Form

Full Name*

Age

Vision Preferences and Needs

Do you have any issues with light sensitivity?

Do you play any sports

What do you do for work?

What do you currently wear?

What lens options do you currently have on your glasses?

How do you feel about your current glasses and/or contact lenses?

I love themReady to update and get a fresh lookI currently don't wear any correctionI'm not really sureThey uncomfortableOther

Are you interested in learning more about different lenses or frame options available?

Do you experience any eye strain or discomfort after using digital devices?

Do you spend a lot of time outdoors?

Are you exposed to any specific environment that affects your eyes( E.G dry air, high humidity, bright sunlight, heat) ?

What's your personal style and fashion preferences when it comes to eyewear

What's your budget for eywear?

Are you open to trying different looks or styles?

What colors do you think look best on you?

How often do you change your hair color?

Do you have any specific brands or material you prefer for your eyewar ( E.G titanium, acetate, eco-friendly options) ?

How important is it for your eyewear to reflect your personality?

How important is it for your eyewear to be lightweight ?

Are you allergic or have sensitivity to any materials ?

Have you had any issues with previous eyewear? ( E.G breakage, damaged lenses, mismatch, discolor, etc.)

YesNo

Are you considering purchasing multiple pair?

Are you interested in learning about or exploring future options like prescription sunglasses or specialized lenses available?

What did you like most about your last pair of glasses?

What do you value about your lifestyle

Would you be interested in receiving updates about new eyewear styles, special promotions and personalized services we offer?

Are you looking for eyewear that transitions to dark lenses when you go outside?

What do you want most from your new eyewear?

Is There Anything Else Youd Like to Share That Would Help Us Find the Perfect Eyewear for You

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Lifestyle-questionnaire

The Optical Experience

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The Optical Experience

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Contact Info

Hours of Operation

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