Find out if you could have Dry Eye Disease by taking our quick questionnaire designed by the experts at Lumenis.Select the most appropriate answer for each question to find out whether or not you may be suffering from dry eye disease. During a typical day in the past month, how often did your eyes feel discomfort? * 0 - Never 1 - Rarely 2 - Sometimes 3 - Frequently 4 - Constantly When your eyes felt discomfort, how intense was this feeling of discomfort at the end of the day, within two hours of going to bed? * 0 - Never 1 - Not at all intense 2 - Slightly intense 3 - Somewhat intense 4 - Fairly intense 5 - Extremely intense During a typical day in the past month, how often did your eyes feel dry? * 0 - Never 1 - Rarely 2 - Sometimes 3 - Frequently 4 - Constantly When your eyes felt dry, how intense was this feeling of dryness at the end of the day, within two hours of going to bed? * 0 - Never 1 - Not at all intense 2 - Slightly intense 3 - Somewhat intense 4 - Fairly intense 5 - Extremely intense During a typical day in the past month, how often did your eyes feel excessively watery? * 0 - Never 1 - Rarely 2 - Sometimes 3 - Frequently 4 - Constantly Name First Name Last Name Email * Phone (###) ### #### Who is your Optometrist? (If you do not have a dedicated Optometrist please leave blank) Thank you!
