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You could have dry eye and not even know it!
Answer these 5 questions to find out!
*Required Information
Take a moment to fill out this survey regarding your Dry Eye condition, and our team of experts will be in touch to assist. This survey is for informational and educational purposes only. It is not intended or implied to be a substitute for professional medical advice and may not apply to every individual. You may contact our office for additional information and schedule an appointment.
*Name:
*Email:
Phone:
During a typical day in the past month, how often did your eyes feel discomfort?
0
Never
1
2
Sometimes
3
4
Constantly
When your eyes feel discomfort, how intense was this feeling of discomfort at the end of the day, within two hours of going to bed?
1
2
Not intense at all
3
4
5
Very intense
During a typical day in the past month, how often did your eyes feel dry?
0
1
Never
2
3
Sometimes
4
Constantly
When your eyes felt dry, how intense was this feeling of dryness at the end of the day, within two hours of going to bed?
1
2
3
Not intense at all
4
5
Very intense
During a typical day in the past month, how often did your eyes look or feel excessively watery?
0
1
Never
2
3
Sometimes
4
Constantly
Please fill in all required fields above.