Help us understand your eyewear habits and history to provide personalized care recommendations.
How many pairs of eyeglasses do you currently own and actively rotate?
What is your primary pair type?
Single Vision
Progressive/Bifocal
Reading Glasses
Prescription Sunglasses
Blue Light Blocking
Other
Please specify your primary pair type:
How many years have you been wearing prescription eyeglasses?
Less than 1 year
1-3 years
4-7 years
8-15 years
More than 15 years
On average, how many hours per day do you wear your glasses?
Less than 4 hours
4-8 hours
8-12 hours
12-16 hours
16+ hours (almost constantly)
Do you also wear contact lenses?
Please describe your contact lens usage pattern and how it affects your glasses wear:
Evaluate your typical daily experience with your current eyewear.
Rate your overall daily comfort level (1 = Very Uncomfortable, 10 = Perfectly Comfortable)
Which areas of your face/head experience the most discomfort or pressure? (Select all that apply)
Nose bridge
Behind ears (temples)
Temples/sides of head
Behind head (from straps)
No discomfort
How frequently do you need to push your glasses back up your nose?
Never
Once or twice a day
Every few hours
Every 30-60 minutes
Constantly
During which activities do you most notice fit issues? (Select all that apply)
Working at computer
Reading
Exercise/sports
Walking outdoors
Driving
Cooking/housework
Social gatherings
All activities equally
Identify specific alignment problems you experience with your frames.
Do your glasses slide down your nose frequently?
When do they slide most?
When looking down
When sweating
During physical activity
All the time
Do your glasses pinch or create pressure behind your ears?
Describe the pinching sensation and when it occurs:
Do your glasses sit crooked or at uneven height on your face?
Describe the crookedness - is one lens higher, or does the frame tilt to one side?
Have you ever attempted to adjust your glasses yourself?
What adjustments did you attempt and what tools did you use?
Why haven't you attempted self-adjustment?
Afraid of breaking them
Don't know how
Prefer professional service
Never needed adjustment
Assess the current condition of your glasses' hardware components.
What nose pad conditions do you observe on your glasses? (Select all that apply)
🟢 Soft & Clear (like new)
🟡 Yellowed or hardened
🔴 Missing pad
Embedded dirt/debris
Metal discoloration underneath
Have the yellowed/hardened pads caused skin irritation?
Are you currently using the glasses without nose pads?
What hinge screw conditions exist on your glasses? (Select all that apply)
Snug and secure on all hinges
Loose/arms wobble slightly
Stripped thread (screw won't tighten)
Missing screw(s)
Squeaking when opening/closing
Do the loose hinges affect the fit on your face?
Describe which hinge is stripped and how it happened:
How do the temple arms align when glasses are closed?
Both arms close perfectly parallel
One arm sticks out slightly
Arms cross over each other
Don't know/never checked
Do you notice any gaps between lenses and frame?
Describe where the gaps appear and if lenses feel loose:
Understand your current maintenance habits to recommend improvements.
How often do you clean your glasses?
Multiple times daily
Once daily
Every few days
Weekly
Rarely
What materials do you use for cleaning? (Select all that apply)
Microfiber cloth
Tissue paper
Shirt/fabric
Commercial cleaning solution
Water only
Soap and water
Alcohol wipes
How do you store your glasses when not wearing them?
Hard protective case
Soft pouch
On table surface
Hang around neck
Leave on head
No consistent method
When was your last professional adjustment or repair service?
How often do you perform DIY maintenance (tightening screws, cleaning, etc.)?
Weekly
Monthly
Every 3 months
Every 6 months
Never
Log each pair's service history to track recurring issues and maintenance patterns.
Glasses Pair Service Record
Glasses Pair | Frame Fit Issue | Nose Pad Status | Hinge Screw Tightness | Adjusted Date | ||
|---|---|---|---|---|---|---|
A | B | C | D | E | ||
1 | Daily Progressive Readers | Sliding Down Nose | 🟡 Yellowed/Hardened | Snug | 11/15/2024 | |
2 | Lightweight Titanium Frame | Pinching Behind Ears | 🟢 Soft & Clear | Loose/Arms Wobbly | 10/28/2024 | |
3 | Prescription Sunglasses | Sitting Crooked/Uneven Height | 🔴 Missing Pad | Stripped Thread | 9/10/2024 | |
4 | ||||||
5 | ||||||
6 | ||||||
7 | ||||||
8 | ||||||
9 | ||||||
10 |
Help us understand what matters most for your eyewear care.
Rate the importance of each aspect of glasses care (1 = Not Important, 5 = Extremely Important)
1 | 2 | 3 | 4 | 5 | |
|---|---|---|---|---|---|
Perfect fit and alignment | |||||
Long-lasting hardware | |||||
Clean, clear lenses | |||||
Quick DIY fixes | |||||
Professional service availability | |||||
Cost-effective maintenance |
Where do you prefer to get adjustments done?
Original optician/optometrist
Any optical shop
DIY at home
Mail-in service
Don't get regular adjustments
Would you be interested in learning professional-level DIY maintenance techniques?
Which techniques interest you most? (Select all that apply)
Screw tightening and replacement
Nose pad replacement
Frame bending and alignment
Lens removal and insertion
Ultrasonic cleaning
Scratch repair
What is your typical budget for annual glasses maintenance (not including new purchases)?
Under $50
$50-$100
$100-$200
$200-$500
Whatever it takes for perfect comfort
Share your overall experience and any additional details.
Overall satisfaction with your current glasses' fit and comfort
How likely are you to recommend your current glasses to someone with similar vision needs? (1 = Not at all, 10 = Definitely)
Any additional comments, concerns, or specific issues not covered above?
Upload photos of any specific fit issues or hardware problems (optional)
I consent to receiving personalized eyewear care tips and maintenance reminders via email
To configure an element, select it on the form.