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