Skip to main content
Home » Contact Us » Online Forms » Ocular Surface Disease (Dry Eye) Questionnaire

Ocular Surface Disease (Dry Eye) Questionnaire

MM slash DD slash YYYY
Name(Required)
MM slash DD slash YYYY
How FREQUENTLY do you experience the following dry eye symptoms?
Dryness, Grittiness or Scratchiness
Soreness or Irritation
Burning or Watering
Eye Fatigue
How SEVERE are your dry eye symptoms?
Dryness, Grittiness or Scratchiness
Soreness or Irritation
Burning or Watering
Eye Fatigue
x

We will be closed Thursday November 24th to November 27th for the Thanksgiving.