Am I suitable? Step 1 of 4 25% 1. Do you have trouble seeing far away or up close without an optical aid? (tick more than one if needed)* Up close(reading) Far away(TV, Driving) Intermediate(computers) 2. What optical aid do you use for correcting your vision currently ?* None Glasses Soft contactlenses Toric softcontact lenses Gas permeablelenses Ortho-Klenses 3. What is your age?*Under 1818-2021-4243-4950-5455+4. Are you interested in seeing well up close (reading) without glasses?*It's very important to me NOT to wear reading glasses.It's not important to me. I do not mind wearing reading glasses to see things up close.5. To understand your visual needs, could you please tell us your occupation* 6. Do you know your approximate visual prescription?*YesNoIf Yes, what are the values for each eye?Is the prescription for your right eye 'Plus +' or 'Minus -' ?Plus +Minus -Right Eye value0.000.250.500.751.001.251.501.752.002.252.502.753.003.253.503.754.004.254.504.755.005.255.505.756.006.256.506.757.007.257.507.758.008.258.508.759.009.259.509.7510.0010.2510.5010.7511.0011.2511.5011.7512.0012.2512.5012.7513.0013.2513.5013.7514.0014.2514.5014.7515.0015.2515.5015.7516.0016.2516.5016.7517.0017.2517.5017.7518.0018.2518.5018.7519.0019.2519.5019.7520.00Is the prescription for your left eye 'Plus +' or 'Minus -' ?Plus +Minus -Left Eye value0.000.250.500.751.001.251.501.752.002.252.502.753.003.253.503.754.004.254.504.755.005.255.505.756.006.256.506.757.007.257.507.758.008.258.508.759.009.259.509.7510.0010.2510.5010.7511.0011.2511.5011.7512.0012.2512.5012.7513.0013.2513.5013.7514.0014.2514.5014.7515.0015.2515.5015.7516.0016.2516.5016.7517.0017.2517.5017.7518.0018.2518.5018.7519.0019.2519.5019.7520.007. Do you have astigmatism?*YesNoIf Yes, what are the values for each eye?Is the astigmatism for your right eye 'Plus +' or 'Minus -' ?Plus +Minus -Right Eye value0.000.250.500.751.001.251.501.752.002.252.502.753.003.253.503.754.004.254.504.755.005.255.505.756.006.256.506.757.007.257.507.758.008.258.508.759.009.259.509.7510.00Is the astigmatism for your left eye 'Plus +' or 'Minus -' ?Plus +Minus -Left Eye value0.000.250.500.751.001.251.501.752.002.252.502.753.003.253.503.754.004.254.504.755.005.255.505.756.006.256.506.757.007.257.507.758.008.258.508.759.009.259.509.7510.008. Has your prescription been stable over the last two years?*YesNo9. Do your eyes hurt after prolonged eyewear use?*YesNo10. Medical conditions, medications & commentsPlease use this area to outline any existing medical conditions and medications you use that might be relevant to your enquiry. First Name*Last Name*Primary Telephone Number*Secondary Telephone NumberWhat is the best time to contact you?*Please Select9:00 -10:00 Mon-Fri10:00-12:00 Mon-Fri12:00 – 14:00 Mon-Fri14:00 – 17:00 Mon-FriAnytimeEmail OnlyEmail Address* How did you hear about us?*Please SelectRecommendation from DoctorRecommendation from OpticianRecommendation from friend/familyMagazineNewspaperGoogleFacebookInternet otherYahoo/BingRadioOther Permission to store your information To communicate with you we need to store your contact information and will do so securely. You can always contact us whenever you wish to have this removed.Transmitting this information, you agree to our Terms and Conditions of communication. To view these terms click or tap on the link and they will be displayed in a new tab or window.Do you permit us to store your data*YesNoPermission to contact you We would like to send you eye related information from Centre for Sight by email or post. We shall always treat your personal details with utmost care, never passing them on to other companies for any reason.Please let us know if you would like us to contact you or not by selecting one of the options below.*Yes please, I’d like to hear about eye care updates and newsNo thanks, I don’t want to hear about eye care updates and newsEmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms. Centre For Sight is based entirely in the UK, with centres in London, Oxshott and East Grinstead.