CL follow up | UNF Eye Center

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First Name

Last Name

Contact Phone Number

DOB

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Are you satisfied with your vision with your CLs?

Yes

No

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Are you satisfied with the comfort of your CLs

Yes

No

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If you are not satisfied with your vision, please provide reasons below:

Far away vision not good

Near vision not good

Far and near both not good

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Are you able to play 11/23 The Woods -Away match?

Yes

No

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Choose your availability:

Deerwood 12/7 Away

1/4 Glen Kernan Away

1/11 Ponte Vedra Inn Away

1/25 Oakleaf Plantation Away

2/8 Huguenot Away

2/15 Baymeadows Away

2/29 The Woods Home

3/21 Deerwood Home

4/4 Glen Kernan Home

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Tel: 904-620-4393 (campus)