Toggle navigation Load unfinished survey Resume later Exit and clear survey default Caution: JavaScript execution is disabled in your browser or for this website. You may not be able to answer all questions in this survey. Please, verify your browser parameters. Survey into the lives of blind and partially sighted people You are about to fill in a short survey which will help determine your suitability to this research project. Please be aware that all data you provide us with will be held in accordance with the data protection policy outlined on our website. For further information please visit https://www.healthcareopinions.co.uk/privacy-policy/ (This question is mandatory) What is your name, contact number and email address? First Name Surname Contact Number Email Address Postcode (This question is mandatory) Please tell us your age. Only numbers may be entered in this field. Your answer must be between 1 and 99 (This question is mandatory) Are you... Choose one of the following answers Male Female Prefer to self-describe Prefer not to say Other: (This question is mandatory) Which region do you live in? Check all that apply East of England East Midlands Isle of Man London North East North West Northern Ireland Scotland South East (other than London) South West Wales West Midlands Yorkshire and the Humber (This question is mandatory) How would you describe your ethnic background? Check all that apply White British White other Mixed/multiple ethnic groups Black/African/Caribbean/Black British Other ethnic group Prefer not to say (This question is mandatory) Do you have any difficulty seeing, or wear glasses or contact lenses? Choose one of the following answers Yes No (This question is mandatory) Do you wear glasses or contact lenses? Choose one of the following answers Yes No (This question is mandatory) And do you wear glasses or contact lenses for... Check all that apply Reading up close Other close-up uses, e.g. sewing (not TV) Distance vision, e.g. TV, walking around To shield against bright lights and sunshine To protect your eyes Cosmetic reasons Other Code all that apply (This question is mandatory) As far as you know, are you registered as severely sight impaired or sight impaired? Choose one of the following answers Registered severely sight impaired Registered partially sight impaired Registered but don’t know which category Not registered (This question is mandatory) Do you generally have any difficulty seeing ordinary newsprint at arm’s length? Choose one of the following answers No difficulty Mild difficulty Moderate difficulty Severe difficulty Cannot do (This question is mandatory) Do you generally have any difficulty clearly seeing the face of someone across a room – that is from 4 metres or 12 feet away? Choose one of the following answers No difficulty Mild difficulty Moderate difficulty Severe difficulty Cannot do (This question is mandatory) Do you generally have any difficulty clearly seeing people or things in the periphery of your vision? Choose one of the following answers No difficulty Mild difficulty Moderate difficulty Severe difficulty Cannot do (This question is mandatory) With glasses or contact lenses, do you generally have any difficulty seeing ordinary newsprint at arm’s length? Choose one of the following answers No difficulty Mild difficulty Moderate difficulty Severe difficulty Cannot do (This question is mandatory) With glasses or contact lenses, do you generally have any difficulty clearly seeing the face of someone across a room – that is from 4 metres or 12 feet away? Choose one of the following answers No difficulty Mild difficulty Moderate difficulty Severe difficulty Cannot do (This question is mandatory) With your glasses or contact lenses, do you generally have any difficulty clearly seeing people or things in the periphery of your vision? Choose one of the following answers No difficulty Mild difficulty Moderate difficulty Severe difficulty Cannot do (This question is mandatory) Does your vision impairment legally prevent you from driving? It does not matter whether you have passed your test, we just want to know whether you are legally able to drive? Choose one of the following answers Yes, I can legally drive No, I cannot legally drive Submit Load unfinished survey Resume later Please confirm you want to clear your response? Exit and clear survey ×
