School Program Survey

Thank you for answering a few questions to let us know about your participation in our Eye Didn't Know That! school program. Your answers will be used to help us improve our offering into the future.

Did you used the Eye Didn't Know That! school program materials that you received?

Yes No

If yes, how did you use the program and what was your experience?

If no, why not?

Do you plan to use the program again?

Do you believe the program is a valuable service in helping you healthy sight education to your patients / students?

Yes No

If yes, what are the most valuable parts of the program?

If no, why not?

Can we contact you and share your experience with others interested in the program?

Yes No

If yes, please provide:

Contact Name:
Preferred E-mail Address:
Business Phone Number:
Alternate Contact Information:

Are you an

	Eye Care Professional
	Educator
	Other

Do you have any success stories, teaching tips or other information you'd like to provide that we can post to the Eye Didn't Know That! website?

Would you like us to send you an e-mail as new program elements become available?

Yes No

If yes, please provide:

Preferred E-mail Address:

The contents of the Eye Didn't Know That! Site, such as text, graphics, images, and other material contained on the Eye Didn't Know That! Site ("Content") are for informational purposes only. The Content is not intended to be a substitute for professional eye care advice, diagnosis, or treatment. Always seek the advice of your eye care professional with any questions you may have regarding an eye condition. Never disregard professional advice or delay in seeking it because of something you have read on the Eye Didn't Know That! Site.