Eye Exam - University Vision

Welcome!

Welcome to the website for University Vision, your local Eyecare specialist here at the University of Leeds. Based in the Student Union Buildings, we are conveniently situated to provide students, staff and members of the public with a high quality service.


	Eye Exam If you would like to request an eye appointment online then please complete this form and we will contact you by telephone during working hours, Monday to Friday 9am-5.30pm (GMT) excluding Bank Holidays, to confirm your appointment. * Title: * Name: * Surname: * Date of Birth: * E-Mail: * Daytime Tel: * Alternative Tel: House Number: * Postcode: Do you suffer from diabetes?: Yes No Do you suffer from glaucoma?: Yes No When was your last eye exam?: Which optician did you visit?: Eye exam: Contact lens fitting: Contact lens checkup: 1st appointment date: 1st appointment time: AM PM Any 2nd appointment date: 2nd appointment time: AM PM Any 3rd appointment date: 3rd appointment time: AM PM Any Select practice: If you require a specific appointment time, please indicate: Where did you hear about us?: If you wish to receive further information, please tick this box:

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