Dry Eye Quiz Name* First Last Email* PhoneHow often do you experience redness in your eyes?NeverRarelyOftenAlwaysHow often do you experience a sandy/girtty sensation?NeverRarelyOftenAlwaysHow often do you experience excessive water/mucus?NeverRarelyOftenAlwaysHow often do you experience burning sensation?NeverRarelyOftenAlwaysHow often do you experience blurry vision?NeverRarelyOftenAlwaysAre your eyes sensitive to light?NeverRarelyOftenAlwaysAre your eyes sensitive to wind?NeverRarelyOftenAlwaysAre your eyes sensitive to computer screens?NeverRarelyOftenAlwaysAre your eyes sensitive to heat?NeverRarelyOftenAlwaysAre your eyes sensitive to contact lenses?NeverRarelyOftenAlwaysDo you ever experience eye strain?YESNODo you blink your eyes excessivley?YESNODo you use over the counter drops or ointments?YESNOIf YES, how often?Rarely1-2 times per day3-4 times per day5 or more per day
