Contact Lens Exam Form
What a contact lens exam form asks, with sample questions on lens type, wearing habits, and eye health.
A contact lens exam form records the patient's current lenses, wearing habits, lens history, and eye and general health before a contact lens exam. The questions on this page are built from a university optometry clinic's questionnaire and an eye practice's new patient form.
Contact lens exam form, handled by the AI Doctor avatar
AI Doctor, a real-time AI healthcare assistant avatar, asks the questions on a contact lens exam form in the patient's own language, strictly following the practice's instructions.
- Intake before the visit. Patients answer online before they arrive, or at a kiosk when they check in.
- Answers ready for the clinician. Clinicians see what the patient said before the visit starts.
- Less workload at the front desk. Staff spend less time handing out forms and entering answers by hand.
- Key details at a glance. The care team sees what matters up front and decides who needs attention first.
The form becomes a natural conversation: patients answer by talking, in their own words. AI Doctor is an information and patient-assistance interface. It collects answers for the care team to review. It doesn't diagnose, triage, or give treatment advice.
Sample contact lens exam form questions
Typical questions, written out so you can see the level of detail. Every practice words its own form differently.
- Are you coming in for a contact lens prescription?Visit reason
- When was your last eye exam?Visit reason
- Do you wear soft or rigid lenses?Current lenses
- Which lens brand and solution do you use?Current lenses
- How many hours a day do you wear them?Wearing habits
- Do you sleep or nap in your lenses?Wearing habits
- Have you worn contact lenses in the past?Lens history
- If you stopped wearing them, why?Lens history
- Have you had eye surgery or an eye injury?Eye history
- Do your eyes feel dry?Eye history
- Which medicines do you take?Health history
- Do you have diabetes or allergies?Health history
These are examples to read, not a form to fill in.
Contact lens exam form: FAQ
What does a contact lens exam form ask?
The sample questions on this page are based on the UC San Diego Student Health Service optometry questionnaire and an eye practice's new patient form. This page groups them into six areas: visit reason, current lenses, wearing habits, lens history, eye history, and health history.
Who fills in a contact lens exam form, and when?
The patient, before the exam. The UC San Diego form says it must be updated at each visit.
Does it ask whether the patient sleeps in lenses?
Yes. The UC San Diego form asks whether the patient sleeps or naps in lenses, and how often.
Does it ask about lens care products?
Yes. Both forms ask which solution the patient uses.
Is there a contact lens exam form template?
The sample questions on this page show a typical set.
What happens after the form is completed?
The eye care team reads the answers before the exam. AI Doctor only collects them and does not advise on lens wear.
Does AI Doctor give medical advice?
No. It collects information for the care team. It doesn't diagnose, triage, or recommend treatment.
Can patient answers stay on our own servers?
Yes. RAVATAR offers on-prem deployment: the platform can run inside your own perimeter, so patient answers stay there. RAVATAR complies with GDPR and the EU AI Act.
Set up your AI Doctor in Genesis AI Avatar Studio
Genesis AI Avatar Studio is where you set up, test, and publish AI avatars for your website, mobile app, or Holobox. No coding or technical skills needed.
- 01Choose the AI Doctor avatar.
- 02Add your practice's FAQs and visit information.
- 03Talk to it, then publish it.
