Online Vision Test 3 - Pott Glasses

Name*

Phone number*

Right Eye*

From which ROW onwards,

the words become blurry and has score of only 1 to 2?

1 (very blur) to 4 (very clear)

Left Eye*

From which ROW onwards,

the words become blurry and has score of only 1 to 2?

1 (very blur) to 4 (very clear)

Purchase order number

If you've purchased glasses, fill in your order number. Else, leave it blank.