Pre-prescription
questionnaire

A few simple questions. And you’re on your way.
Prescription Goggles
Parent/Child Information

Please complete this post-test three months after receiving your child’s Prescription Goggles. These questions gather your impression about your experience using protective eyewear/prescription goggles.

Protective Eyewear

Please answer the following statements about protective eyewear/prescription goggles.

Superspecs is funded by a grant awarded by the Ohio Department of Health, Bureau of Maternal and Child Health Save Our Sight Fund. For more information about the Save Our Sight Fund and how you can help promote good eye health and safety for children in Ohio, visit: saveoursight.ohio.gov