Please help us to help you by returning this survey form. All enquiries will go into a monthly draw to win a Dakota Smith T-Shirt.
  
 
Name: 
Address: 
State: 
Postcode:
Country:
Email:
Phone: 
Fax: 
 
................
 
Age:
   
Company 
Private 
  ....
 
 
Do you currently wear glasses? .......
Yes No
 
or contact lenses? 
Yes No
 
 
.  
If yes........  
  Do you currently wear: 
 
Single vision lenses
Bi focals
Multi focals
 
  How often have you had your eyes professionally tested? 
 

When was the last time you had your eyes tested? 

  For more specific enquiries please select the category of interest: 
 
Spectacle Frames
Genuine Limited Edition Eyewear
Eyewear Solutions for Your Sport
Sunglasses
Contact Lenses (prescription)
Contact Lenses (iris colour changing)
Contact Lenses (to improve defective colour vision)
Spectacle Lenses (prescription) 
Thinner Lenses for Your Spectacles
 
Further Requests:
 
Note: If you have any queries, please email us at enq@eyeworks.com.au