PARTICIPATE IN OUR TESTS

Would you like to help us? Please fill in the application form below

You can help us to develop and evaluate solutions to improve the autonomy and the quality of life of visual impaired people. The tests will be realized within the Vision Institute or nearby and will be completed by an interview and a visual checkup. You thus have to be able to come to the Vision Institute (Paris 12th district).

Contact details

Salutation
 

You prefer to be contacted by: (required)




You are: (required)



What is your visual pathology? (required)










You know your visual acuity (/10) :

By which ophthalmologist are you under the care ?

Do you have an associated disease?



Do you suffer from a hearing affliction?



If so, do you wear a hearing aid?

How do you move?




How did you know the Vision Institute? (required)

Is it possible for you to come to the Institute of the Vision (Paris 12th district) to participate in a test ?