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I am interested in volunteering to participate in studies conducted at the Institute for Eye Research.
I agree that I would like to be contacted for further information.
I agree that my details may be added to the database for future studies.
 
Title:
Mr
Mrs
Miss
Ms
Dr
First Name*:
Last Name*:
Gender*:
Male
Female
Date of Birth*: (eg. dd/mm/yyyy)
Contact details*: complete all, please click prefered contact
Mobile Number:
Email:
Home phone:
Business phone:
Address:
 
 
1. I currently wear
  Spectacles (Yes - I have tried contact lenses before )
  Contact Lenses
2. Do you wear spectacles or contact lenses?
  To see in the distance
  To read a book
  Or both of the above
3. I last wore contact lenses
  More than 12 months ago
  Within the past 12 months
4. Type of contact lenses that I wear:
  a) Rigid Gas Permeable (hard) contact lenses:
  Daily wear
  Extended wear (sleep overnight in lenses)
     
  b) Soft contact lenses:
  Daily wear
  Extended wear (sleep overnight in lenses)
  For Astigmatism (toric lenses)
  c) Other (please specify):
 
*required
 

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