EyeDropShop | Dry Eye Symptoms Questionnaire
Take this quick Dry Eye Questionnaire and bring it along with you to your appointment with your eye doctor.
www.eyedropshop.ca
Email address *
My eyes feel really dry. *
It feels like there's something in my eyes. *
My eyes feel like they’re stinging or burning. *
My vision gets blurry. *
My eyes get red or irritated. *
My eyes get teary. *
My contact lenses bother me. *
I use artifical tears ______ times a day. *
Your answer
My symptoms get in the way of... *
Required
A copy of your responses will be emailed to the address you provided.
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