Eyewear Fit Issue Report Form
Report problems with the fit of your eyewear to help us assist you promptly.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Brand of Eyewear
*
Model Name or Number
Date of Purchase
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Where did you purchase your eyewear?
Please Select
In-store
Online
Optometrist
Other
What type of fit issue are you experiencing?
*
Too tight
Too loose
Slips down nose
Uneven fit
Hurts behind ears
Other
When did you first notice the fit issue?
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Please describe the fit issue in detail
*
Have you attempted any adjustments or repairs?
Yes
No
Upload photos showing the fit issue (optional)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Additional Comments or Information
Submit Report
Should be Empty: