Venue: Victoria Hotel, Chadderton, Oldham, OL98DE Date: 14 June 2016 Time: 6:30pm - 8:30pm Full Name: Practice Name: GOC Number (if applicable) Telephone Number Email Address (for organisational purposes only) Practice Address Occupation Contact Lens Optician Optometrist Dispensing Optician Store Owner Director Practice Manager Other How many years fitting experience do you have? None 1-3 years 4-6 years 7-10 years Over 10 years On a scale of 1-10 how confident do you feel discussing Contact Lenses? - Select -12345678910Not applicable On a scale of 1-10 how confident do you feel with the details of the CooperVision range of products? - Select -12345678910Not applicable On a scale of 1-10 how confident do you feel fitting Multifocals? - Select -12345678910Not applicable On a scale of 1-10 how motivated do you feel to discuss Contact Lenses with patients? - Select -12345678910Not applicable What is your current rate of success in fitting multifocal lenses amongst your patients? - Select -10%20%30%40%50%60%70%80%90%100%Not applicable Dietary Requirements (leave blank if none) Leave this field blank