Questionnaire for Health Care Professionals
Design
Select
ALK
Aphakic
Avanti
Bandage
CD
CLPL Keratoconus
DuraWave
Eureka
High Myopic
HydroWave
Igel Rx
Igel Mono
Igel Pro
KeraSoft AV
KeraSoft 2
KeraSoft 3
KeraSoft IC
KeraSoft Thin
McGuire
Presto
Prima
Rx
RxT
SAM MF
Simplon
Topflex
Woodward
Xtralens
Zero6
Material
Select
Cosmetic
Select
No
Yes
Order No.
1) Did the patient find the lenses easy to handle?
Strongly Agree
Agree
Undecided
Disagree
Strongly Disagree
2) How many hours does the patient wear the lenses per day?
0-3;
3-6;
6-9;
9+;
3) How many hours of good comfort did the patient receive?
0-3;
3-6;
6-9;
9+;
4. Did the patient achieve expected VA?
No
Yes;
If no, how many lines less than the expected V/A?
5) Have you experienced any issues with lens reproducibility when fitting our lenses on this patient?
No
Yes;
Please rate the reproducibility.
Excellent
AboveAverage
Average
BelowAverage
Poor
6) Are you happy for us to contact you regarding your feedback?
No
Yes;
Complete below
Name
Company
Number
Email