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Thank you for your willingness to participate in an upcoming EnChroma media, social media or testing opportunity. Your answers to the following questions will be shared with media to help them understand who you are, how color blindness affects you and what you hope to be able to experience with EnChroma glasses (or have experienced if you've already tried them). The questions will also help us determine the optimal EnChroma glasses for you to try.

By filling out this form you agree that the information can be shared with media and/or social media and that you're willing to speak with media (if applicable). Thank you.

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* 1. Please provide your Name, Address & Phone and email address:

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* 2. Have you tried EnChroma glasses before?

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* 3. Please type in the media opportunity that you wish to participate in or that you've been invited to participate in (if you know):

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* 4. Please type in the city or town where you live, including the country (if it's not in the U.S.)

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* 5. Please select your color blindness type. Within red-green color blindness there are two types: deutan and protan and severity levels of mild, moderate or strong. If you're unsure, click here to visit enchroma.com and take our color blindness test, which takes 1.5 minutes to complete. Type in your result below please.

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* 6. Do you wear prescription glasses for other vision issues besides for reading or driving?

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* 7. Type in your age:

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* 8. Type in what you do you for work (or if you're a student):

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* 9. Type in your approximate age when, and how, you first found out that you’re color blind:

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* 10. Please describe how color blindness has affected you socially or when you were in school?

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* 11. Please describe how being color blind affects you in your job?

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* 12. How does color blindness affect you in your daily life?

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* 13. What do you hope the EnChroma glasses will do for you?

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* 14. Where do you want to visit or what do you most want to experience in fuller color or do while wearing EnChroma glasses?

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* 15. If you're in the US, please visit EnChroma.com and type in your top two choices for indoor and outdoor glasses. If you're in the UK or Europe, please visit https://enchroma.co.uk/. Depending on availability, we will try to send your top choice.

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* 16. Do you want to receive indoor or outdoor glasses? (the outdoor glasses tend to give more of a "wow" experience partly because natural outdoor light is consistent and nature's colors can be more evocative, but the indoor glasses work well too).

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* 17. Are you willing to speak with media about your experiences being color blind and can we share your answers to these questions with media?

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* 18. Do you grant EnChroma the non-exclusive rights to use and edit any videos, photos or quotes related to your experiences with EnChroma glasses, and your image and name, in our marketing (such as media stories, social media posts, video compilations, digital and/or print ads on Facebook, Google or other platforms, etc.)? You will still own the rights to all of the above and be able to use them as you wish.

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* 19. What to Expect When you Try EnChroma: If this is your first time trying EnChroma, be aware that the first time you try the glasses you could have an instant, powerful effect or it could take a few minutes to as much as 5+ minutes for your eyes and brains to adjust the first few times you wear the glasses. Each time you put them on that acclimation period will decrease until it’s instant every time.

About 30% of people have a “WOW” instant effect, but even if you acclimate more slowly you’ll get the same benefits as those who acclimate instantly. However, even if you’re in the slower effect category you should notice some difference right away.

Be aware that you won’t get 100% color vision, reaction times vary and you will still get some colors wrong. However, you should experience an expanded range of colors that you can see, and colors should be more vibrant, clear and distinct and enjoy improved depth and detail perception too. The glasses work for 9 of 10 people who are color blind.

We hope EnChroma glasses will enable you to experience a new world of color and help you with some of the daily frustrations and issues that color blindness can cause at work and in life. We really appreciate your willingness to try EnChroma and value your time. If you have any other comments, questions or concerns please type them in below.

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