Contact Lens Comfort Study Interest Form
Express your interest in participating in our study on contact lens comfort. Please complete the following form to help us determine your eligibility.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Age
*
Do you currently wear contact lenses?
*
Yes
No
What type of contact lenses do you wear?
*
Soft lenses (daily/monthly)
Rigid gas permeable (RGP) lenses
Colored lenses
Other
How long have you been wearing contact lenses?
*
Please Select
Less than 6 months
6 months to 1 year
1-3 years
More than 3 years
On average, how many hours per day do you wear your contact lenses?
*
Please Select
Less than 4 hours
4-8 hours
8-12 hours
More than 12 hours
How would you rate the comfort of your contact lenses?
*
1
2
3
4
5
Have you experienced any of the following issues while wearing contact lenses? (Select all that apply)
*
Dryness
Redness
Irritation
Blurred vision
No issues
Other
Please describe any additional comments or experiences related to your contact lens comfort.
Are you interested in being contacted for participation in our contact lens comfort study?
*
Yes, I am interested
No, not at this time
Submit Interest
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