Eye Strain Prevention Recommendation Form
Complete this form to receive tailored recommendations for preventing eye strain. All questions are designed to help you improve your comfort and eye health.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
On average, how many hours per day do you spend looking at digital screens?
*
Which devices do you use most frequently?
*
Desktop/Laptop Computer
Tablet
Smartphone
Monitor (External)
Other
Do you currently experience any of the following symptoms?
*
Eye fatigue
Dry eyes
Blurred vision
Headaches
Neck or shoulder pain
None of the above
How would you describe the lighting in your primary workspace?
*
Bright and natural
Bright but artificial
Dim
Varies throughout the day
How often do you take breaks away from your screen?
*
Every 20 minutes or more frequently
Every 30-60 minutes
Every few hours
Rarely or never
Do you use any blue light filters or screen protection features?
*
Yes, always
Sometimes
No
Not sure
Are you familiar with the 20-20-20 rule for eye strain prevention?
*
Yes, and I practice it regularly
Yes, but I rarely practice it
No
Please share any specific concerns or goals related to eye strain prevention.
Submit
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