ROK Participants Form
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First Name
Last Name
Date of Birth
Email Address
Contact Number
Do you have any of the following eye conditions?
No
Keratoconus
Corneal Dystrophies
Allergic/Infectious conjunctivitis
Corneal infections
Previous eye surgery or trauma
Eye lid infections
Dry Eyes
Other…
Enter other…
Do you wear correction for:
Myopia (short sightedness)
Hyperomia (Long sightedness)
Astigmatism
I wear correction lenses but I am unsure what they are for
What type of correction do you wear to correct your eyesight?
Spectacles
Soft contact lenses
Rigid contact lenses
None
Leave this field blank