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Questionnaire

Please submit this form prior to your eye exam so that we may better serve your eyewear needs

Do you currently wear any type of Glasses?
Do you currently wear any type of Contact Lenses?
How many hours per day do you work on a Computer?
 
Fort Myers Eye Associates, PA | Drs. David Dalesio & Sandra Eveleth | 8801 College Parkway, Suite #3 | Fort Myers, FL 33919 | 239.437.2004
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