Daily Contact Lens Tracker Form
Track your daily contact lens wear, comfort, care, and replacement status.
Date of Entry
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Type of Contact Lens Worn
*
Please Select
Daily Disposable
Bi-weekly
Monthly
Rigid Gas Permeable
Other
Hours Worn Today
*
Comfort Level During Wear
*
1
2
3
4
5
Did you experience any discomfort or issues?
No issues
Dryness
Redness
Blurry Vision
Irritation
Other
Lens Cleaning Method Used
*
Please Select
Multipurpose Solution
Hydrogen Peroxide Solution
Saline Solution
Rinsed Only with Water (not recommended)
No Cleaning (daily disposable)
Other
Lens Storage Case Cleaned Today?
*
Yes
No
Not Applicable (daily disposable)
Were your lenses replaced today?
*
Yes, replaced with new lenses
No, continued using current lenses
Left/Right Eye Notes (if different for each eye)
Additional Notes
Submit Entry
Should be Empty: