Complete Home Lighting & Eye Comfort Assessment

Full Name

Home Address (optional, for solar orientation analysis)

Age Range

Primary activities you perform in your home (select all that apply)

Describe your typical work setup (desk location, hours per day, type of computer work):

Describe your creative work and its specific lighting needs:

Do you wear vision correction?

Do you experience glare or reflections on your glasses from indoor lighting?

Describe when and where glare on glasses is most problematic:

Do you find that contact lenses dry out more in certain lighting conditions?

Which rooms or times of day cause the most dryness?

When did you have your eye surgery?

Have you been diagnosed with any of these eye conditions? (select all that apply)

Do you currently experience regular eye strain, headaches, or visual discomfort at home?

Please describe the frequency, intensity, and specific symptoms you experience:

How would you rate your overall eye comfort level in your home?

Room Lighting Observations

Did you notice any rooms that appear dark or shadowy even when lights are turned on?

Which rooms and what specific areas within them suffer from inadequate lighting?

Are there any rooms where lighting feels excessively harsh, causing glare or discomfort?

Describe the harsh lighting issues and which fixtures cause discomfort:

Total number of overhead light fixtures in your home

What types of light bulbs are predominantly used in your home? (select all that apply)

Do you notice flickering with fluorescent tubes?

Describe the flickering pattern and affected locations:

Which smart lighting brand and do you use scheduling features?

What color temperatures (in Kelvin) are your bulbs? Check packaging or manufacturer specs if uncertain.

Do you have dimmer switches installed for any overhead lights?

What type of dimmer technology?

Would you consider installing dimmers to control light intensity?

Do you use task lighting (desk lamps, reading lamps, under-cabinet lights)?

What types of task lighting do you use?

Are any lights positioned causing direct glare into your eyes or reflective glare on screens?

Describe the problematic light positions and affected activities:

What is the primary orientation of your main windows?

What window coverings do you have? (select all that apply)

Do external factors block natural light (buildings, trees, awnings)?

Describe the obstructions and which windows are affected:

Do you experience intense glare or heat from direct sunlight at certain times?

When and where does solar glare cause discomfort or force you to adjust your position?

What type of glass is in your main windows?

How frequently do you experience eye strain in your home?

Which specific symptoms do you experience? (select all that apply)

Describe headache patterns, triggers, and severity:

Describe migraine light triggers and recovery needs:

Do you notice eye fatigue worsens after sunset?

Describe the progression of symptoms throughout the day:

When are symptoms typically at their worst? (select all that apply)

Which activities or tasks cause the most eye strain? (select all that apply)

Is your computer screen positioned perpendicular to windows to reduce glare?

Describe your current screen positioning relative to light sources:

Do kitchen lights create shadows on your work surfaces while cooking?

Which surfaces (countertops, stove, sink) are most problematic?

Have you ever had an eye exam specifically due to home lighting-related discomfort?

When was this exam?

Average daily screen time (hours) on all devices combined

Which devices do you regularly use at home? (select all that apply)

How do you typically set your screen brightness?

Do you use blue light filtering features on your devices (Night Shift, Night Mode, f.lux)?

When are these filters active?

Would you be interested in learning about blue light management for eye comfort?

How far is your primary screen from the nearest window?

Do you experience screen reflections or glare from overhead lights or windows?

Describe the reflection sources and how you currently mitigate them:

How do you currently control your lights? (select all that apply)

Do you have any smart home lighting integration?

Can you easily adjust lighting levels throughout the day without major inconvenience?

What barriers prevent easy lighting adjustments?

Do you use automated lighting schedules (e.g., gradual brightening in morning, dimming at night)?

Describe your lighting schedules and their effectiveness:

Which rooms would you prioritize for lighting improvements? (select up to 3)

What types of lighting improvements interest you most? (select all that apply)

Are you interested in lighting that automatically adjusts based on time of day?

Which automation feature appeals most?

Would you like lighting that supports better sleep quality?

What sleep-related issue would you like to address?

Rank these lighting improvement goals in order of importance to you (drag to reorder, 1 = most important):

What is your preferred overall lighting quality?

What is your approximate budget range for lighting improvements?

What is your preferred timeline for implementing changes?

How do you prefer to implement lighting changes?

How important is energy efficiency and sustainability in your lighting choices? (1 = not important, 5 = extremely important)

Are you open to trying non-traditional lighting solutions (e.g., bias lighting behind screens, light therapy lamps, tunable white systems)?

Describe any specific lighting technologies you'd like to explore:

Any other observations about your lighting or eye comfort that weren't covered?

Preferred method for receiving your personalized lighting audit report and recommendations

Would you like to receive periodic follow-up check-ins to assess improvement progress?

Preferred check-in frequency

Signature (for professional audit verification)