1) In which sector do you work? A-Private sector B-Government sector C-Own business D-Unemployed 2) What is your occupation?

A-Engineer B-Doctor C-Teacher D-Industrialist E-farmer F Others......................... (Please specify) 3) Do you wear spectacles? A-Yes B-No 4) If you wear spectacles, how long have you been wearing so? A->5years B-5-3 years C-3-1 years D-recently 5)Are you aware of eye donation? A-yes B-No 6)Are you willing to donate your eyes? A-Yes B-No 7)Is there any person suffering from blindness or eye problem in your family? A-Yes B-No 8) Are you aware of scarcity of eyes in India? A-Yes B-No 9) Do you know someone who has donated eyes? A-Yes B-No 10) Can you specify reasons for unwillingness to eye donation?

A) B) C) D)

Lack of awareness Considered as taboo Health problems Other reasons...........................(specify)

11) How have you come to know about eye donation? A) B) C) D) E) I am unaware By TV By magazine By online social media From a friend

12) What is your education level? A) B) C) D) E) F) 10th pass 10+2 Graduate Postgraduate PhD Illiterate

13) What is your religion? A)Hindu B)Muslim C) Christian D) Other.............(speicify) 14) What is you age group? A) B) C) D) <25 years 25-35 years 35-50 years >50 years

15) What is your gender? A) Male B) Female 16) Does your job demand constant working with the computer for majority of the day? A-yes B-No 17) Are you willing to receive donated eye if required for any member of your family or relatives? A-Yes B-No 18) In which part of India do you presently live?

A-Northern India B-Southern India C-eastern India D-Western India 19) Do you or any member of your family has undergone any operation in recent time? A-Yes B-No 20) Is there any doctor in your own family? A-Yes B-No 21) Is there any doctor in your relatives? A-Yes B-No 22) Are you aware of any eye banks in India? A-Yes B-No 23) Will you donate eyes if monetory benefit is provided ? A-Yes B-No 24) Do you suffer from any physical deformity? A-Yes B-No 25)