Request a Consultation

Consultation Request Form

Please complete the form below and we'll connect with you shortly. To discover your child's risk for myopia or the risk of progression, take this short survey. With only a few questions, it can estimate the level of risk of progressive myopia and what you can do to help them.
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Parent's Name

Child's Name

Email

Phone Number

How old is the child?

Is the child already nearsighted or myopic?
(wears correction to see better in the distance)

Are the child's parents myopic?

How many hours a day does the child spend outdoors?
(including breaks or recess at school)

*A team member will reach out to you regarding your results. Please give us at least 24 hours.