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Basic Customer Informations

Let's start with some of your basic informations

What is your name? *
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Date Of Birth*
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Phone Number*
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How did you know about us?*
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Where do you live?*
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Lifestyle Questions

Answer questions about your lifestyle so we know what's best for you!

What is the reason of purchasing your new glasses? *
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How often will you wearing your glasses? * *
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Do you face any eyes problem recently? * *
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Do you have/undergo any eye disease/injury/surgery? * *
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Are you allergic to metal material? * *
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Your current lenses features: * *
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Email *
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