Natural Vision Family Welcome

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Welcome to the Natural Vision Family!

Together we will support our eyes optimal health and functioning and grow Holistic Eye Care as an Alternative Health Option.

Please create your Member Log In and Complete your Vision History & Goals Form.

1. Create Username & Password

* Indicates required field

Name *

First

Last

[object Object]

email *

Submit

2. Vision History Questionairre & Goals Form
- so we know who is in our Family !

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

How did you here about the Natural Vision Centre/School? *

Please select the Categories that represent your vision Concerns *

Myopia (Need Glasses to Drive) I'm starting to need Drugstore Readers I have Bifocals/Trifocals or Progressives One of my eyes is worse than the Other I have Lazy Eye (known clinically as Amblyopia) I have a Degenerative Disease ie) Macular Degeneration or Retinitis pigmentosa I have other complications. eg. Retinal Tears, Macular Pucker, Cataracts or Glaucoma, I Struggle with Headaches and Eyestrain I work for long hours at a Computer

In Your own words please describe your main reason for joining the Natural Vision Family. What aspect of the program is most important to you? *

What Days/Times are best for you to attend Live Q&A & Support Meetings? Please keep in mind The Natural Vision School is Mountain Standard Time. *

Weekdays Weekends Mornings 9 am MST Evenings 7pm MST Lunch Noon 12 pm MST

Days/Times that absolutely do Not work for you to attend On-Line support Calls *

Do you Wear Contacts of Glasses? If so for how many hours a day? *

Recall your life when you first noticed difficulties with your vision (including 18 months prior to needing glasses). What was going on? Had you recently moved; experienced difficulties with a teacher; changed jobs; had relationship difficulties; etc? *

At what age did you get your first pair of glasses/contacts? *

Has the eye doctor ever told you that even with lenses you do not see 20/20? in one eye *

Yes No

Current prescription details. Please complete as you see it on your prescription form. *

How many hours a day do you spend: Outside, On Computer, Reading, Driving, T.V./ Video Games *

What factors do you notice affect your vision? *

Do you Experience any of the following: If Yes, Please Check *

Tilt your head to one side or use one eye when you read Difficulty Night Driving Light Sensitivity Motion Sickness Difficulty with Sports - coordination & catching balls Driving and being able to assess distances between cars

What in your life do you currently find stressful? And, How do you typically deal with stress? *

What are your Vision Goals? *

Have you been diagnosed with an eye disease or complication, if so what? *

Are you currently being treated for a medical problem? If so please name what it is. *

Do you follow a Nutritional Program or restricted diet? And/or an exercise routine? *

Submit

home
Book/Contact
My Symptoms
Resources
Classes
- My Mind-Body Medicine School
Programs
- Level 1 Courage to Heal >
  - Investment Options >
    
    Investment Options Healing Mentorship
- LEVEL 2 Courage to Heal Deep Dive Professional Program

Welcome to the Natural Vision Family!

​​Please create your Member Log In and Complete your Vision History & Goals Form.

​​​1. Create Username & Password

2. ​Vision History Questionairre & Goals Form​- so we know who is in our Family !

​

Please create your Member Log In and Complete your Vision History & Goals Form.

1. Create Username & Password

2. Vision History Questionairre & Goals Form
- so we know who is in our Family !