Please complete form below at least 48 hours prior to Eye Examination. 

Due to new guidelines set out by the States of Guernsey we would ask you to under go a Lateral Flow Test on the morning of your appointment and to wear a mask when entering the practice. 

If you are experiencing any Covid symptoms, please do not attend the practice.

Reason for visit?
Please tick the boxes below if you suffer from any of these symptoms, in the large box please supply details of how long you have had them, if they have worsened, how long the last and any triggers)
Do you wear contact lenses?