Lifestyle Evaluation
(If you've never worn glasses before, please skip to question 5)

1. How many pairs of glasses do you currently use?
1_____ 2_____ 3 or more _____

2. Do you wear prescription glasses while you spend time outdoors?
Yes_____ No_____

3. Are they tinted for sun protection?
Yes_____ No_____

4. Describe any vision problems you've had with previous glasses: ________________________________________________________________

5. How many hours a day do you spend
At work?_____ Reading?_____ Watching TV?_____

6. How many hours a day do you spend outdoors?_____

7. Are your eyes sensitive to bright light or glare?
Yes_____ No_____

8. Describe the type of light you are usually in?
Soft home lighting_____ Florescent office lighting_____
Retail lighting_____ Indoors with natural light_____
Outdoors in natural light_____ Other____________________

9. Is it essential for you to see more clearly at one specific distance than others?
Distance?____ Arm’s length?_____Close up?_____

10. Are you engaged in a hazardous occupation or in contact sports?
Yes_____ No_____

11. Is a fashion image important to you?
Yes_____ No_____

12. Is there a particular style of frame or lens that interests you?
_________________________________________________________________