Dynamic Vision Questionaire

Tell us a little about yourself

This helps your optometrist understand your needs before your eye test.

Patient name Practice Email address Mobile number Age group Do you currently wear glasses? What do you mainly use them for? Do you currently wear multifocal / progressive lenses?

What does a typical week look like?

Select all that apply.

Which of these do you experience?

Select all that apply.

If you had to pick one thing today...

There’s no wrong answer — this helps guide the recommendation.

Anything else your optometrist should know?

Thank you

Your Vision Profile has been sent to your optometrist and will be discussed during your consultation.

Tell us a little about yourself

What does a typical week look like?

Tell us about your child’s lifestyle

What activities do they enjoy?

Which of these do you experience?

Which of these have you noticed?

If you had to pick one thing today...

Thank you