Pre – Assessment questionnaire

To reduce the amount of time our optician spends face to face we are asking patients if they mind answering a few questions before they come in for their appointment. These questions are the history and symptoms and are routinely asked at an appointment. We will either do this by phone or by an online form.


If you would prefer to do this online, the link to the form is http://www.smartsurvey.co.uk/s/8V2RWI/


Please make sure you input your full name so we can link your submission to your record.


All results once put into your sight test record will be deleted off the website. For more information about our privacy policy and a link to Smart Survey’s policy please visit cotswoldeyecare.co.uk/privacy-policy/

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