Visit date * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20212022 Subject ID * Site no. * Patient gender * Male Female Age * 1. Prior to being fitted with MiSight® 1 day, what type of correction were they wearing? * Myopia managed with multifocal or bifocal spectacles Myopia managed by Orthokeratology Myopia managed by multifocal contact lenses No correction previously required Corrected with single vision spectacles Corrected with single vision contact lenses Other - please specify 1. Prior to being fitted with MiSight® 1 day, what type of correction were they wearing? Other - please specify 2. How easy was it to fit MiSight® 1 day? * As easy as any daily disposable soft spherical contact lens Somewhat easy Not very easy 3. How long did the application and removal teach take? * Up to 30 mins 30 mins to 60 mins A repeat visit was necessary A teach was not required 4. Who conducted the application and removal teach? * The practitioner Support staff A teach was not required 5. When recommending MiSight® 1 day contact lenses, which of the following concerns did the parent / guardian raise? * None Too young to wear contact lenses Cost Concerns about eye health with contact lenses Concerns about required wearing times Concerns about comfort 6. Which benefit appealed MOST to the child’s parent / guardian before accepting MiSight® 1 day as an option? * Efficacy of 59% (reduction in the future prescription) Being spectacle free Lower risk of future eye health risk (retinal detachment, myopic maculopathy, glaucoma) It is a soft daily disposable lens Leave this field blank
