Dry Eye Questionnaire
Email address *
Name *
Your answer
Phone
Your answer
1. My eyes are sensitive to light.
2. My eyes feel Gritty.
3. My eyes feel tired.
4. My vision gets blurry.
5. I have difficulty with driving at night.
6. I have a hard time using my digital device (phone, tablet, computer).
7. I have a hard time wearing my contact lenses.
8. I have been diagnosed with:
A copy of your responses will be emailed to the address you provided.
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