Question 1
What is the age of your child?
Is your child/young adult Myopic (Short-sighted / Nearsighted)?
How many hours per day (average) does the child/young adult play outside in natural daylight?
How many hours per day (average) does he/she spend with close vision tasks? (within arms length distance, time at school not included)
Question 2
Prescription of ‘genetic’ mother. (Skip if you do not want to offer this information)
Amount if known (can be found on eye examination report, ‘prescription’ or contact lens box):
Prescription of ‘genetic’ father. (Skip if you do not want to offer this information)
Amount if known (can be found on eye examination report, ‘prescription’ or contact lens box):