Vision Express Nottingham Engagement Evening

Full Name:

Practice Name:

GOC Number (if applicable)

Telephone Number

Email Address (for organisational purposes only)

If you answered "yes" to the previous question, please enter your full spectacle prescription including reading add & dominant eye.

How would you rate your confidence at multifocal contact lens fitting (1 is low and 10 is high)

What is your current rate of success in fitting multifocal lenses amongst your patients?

Dietary Requirements (leave blank if none)

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