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WPS Optometrists - Request Form

Contact information:
 Information leaflets will only be posted out within the UK - (items marked with a * must be completed)

First name*
Last name*
Title
Address*

Postcode*
Telephone
E-mail*
URL

 

Information leaflet request:
Please send me the following information leaflets (select more than one leaflet if you wish):

WPS Optometrists Newsletter   WPS Optometrists Brochure
The Eye Examination   Your Child's Eyesight
Contact Lenses   VDUs and Your Eyes
Your most Frequently Asked Questions   Seeing Well, Looking Good, Feeling Great
Clear Vision Safe Driving   Leisure Specs
Crazy Contact Lenses   Freshlook Colours
Seiko Lenses   Clearer Hearing
Understanding Diabetic Retinopathy   Understanding Glaucoma
Understanding Nystagmus Understanding Macula Degeneration
Understanding Retinitis Pigmentosa   Understanding Retinal Detachment
See for yourself 1 - Sight Problems   See for yourself 2 - Magnifiers
See for yourself 3 - Lighting   See for yourself 4 - At Home
See for yourself 5 - Leisure at Home      
(if you wish to receive information on a topic not listed fill in the box below)

 

VDU/Safety eyewear information request:

 Send me a VDU/Safety Eyewear catalogue and price list

If you would like us to quote you for performing eye examinations as well please give us some information about the number of employees you have (both VDU and safety) and whether you would like them tested on your premises or if your employees could travel to us.

 

Web link request:

Details of Link Site Name
URL
E-Mail

Type of Site  

Brief Site Description

  

 

Additional comments: