Contact us Please fill out the following form. All fields are required to send a request.   Message:     First Name: Middle Name: Last Name: Complete Name:   Email:   Age:     12 & Below 13-19 24-34 35-44 44 & Above Gender: Male  Female Occupation:     Professional Self-employed Domestic Student Complete Address:     Area:   City:   Country:   Contact and Facsimile Number: (Please specify if you have more than one.) Telephone:   Facsimile:   Globe:   Smart:   Sun Cellular:   Others, please Specify:   Interested In:   Join the mailing list   Join the online promotion   Get invites to events and parties Would you like to inquire about other products? Please check one or more items.    Colored Lenses    Contact Lens for daily wear (8h to 10h use)    Contact Lens for extended wear (>12h up to 24h use)    Contact Lens for continuous wear (>12h up to 30 nights use)    Contact Lens Solution Optical Clinic where you usually purchase your eye care products. Location/Branch:   What lens care products are you using? Please check one or more items.    AOSEPT® Plus  Freshlook® All-In-One    AQuify® Drops  SOLOCARE™ Aqua Is this your first time to try this product? Yes     No If Yes, what brand were you using before? If No, how long have you been using the brand/product you are currently using? Are you a contact lens or spectacle wearer?   Contact Lens     Spectacle   Prescription Grade:     Left    Right   What brands of contact lenses have you tried? Brand 1 Brand 2 Brand 3 How long have you been wearing contact lenses or spectacles?   0 to 1 year   More than 5 years   More than 10 years   Not Applicable How long do you put your contact lenses on?   Daily/Overnight   Weekly   Monthly Not Applicable If you do not have a vision problem, do you have family members or friends who suffering from one? Yes     No   Please provide the following information so you could share our website to your family or friend with vision problems. Name:     Email:     Enter Validation Code       Exclusively distributed by SightCare Products Jeannette Romualdez eyecare@bettereyesforbetterlife.com

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