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NO Are you using any magnifying vision aids PLEASE BRING THIS QUESTIONNAIRE WITH YOU TO THE APPOINTMENT Jan 01. VISION TASK Reading the newspaper LOCATION/ROOM kitchen LIGHTING Overhead light - 2 60w bulbs Does sunlight bother your eyes If you wear sunglasses please bring them. YES Do you wear eyeglasses If yes please bring your newest ones in for your appointment. Please think about different vision tasks that you find difficult and list them below. You might wish to treat this like a diary...

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Name telephone refers to the contact information that includes the name and telephone number of an individual or entity.

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