Skip to main content
Holiday Hours Announcement

We will be closing at 12:00 PM on Tuesday, December 24th. Our office will be closed on Wednesday, December 25th and Wednesday, January 1st. Thank you for your understanding, and we wish you a joyous holiday season!

Book An Eye Exam
Call 952-898-9588
Open Menu
Open Menu
Home » Eye Care Services In Lakeville MN » Dry Eye » What Treatments Can Relieve Dry Eye Syndrome? » Dry Eye Questionnaire

Dry Eye Questionnaire

Please answer the following questions by checking the box that best represents your answer. Select only one answer per question.

1. Do you experience EYE DISCOMFORT?

a. During a typical day in the past month, how often did your eyes feel discomfort?(Required)
b. 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?(Required)

2. Do you experience EYE DRYNESS?

a. During a typical day in the past month, how often did your eyes feel dry?(Required)
b. 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?(Required)

3. Do you have WATERY EYES?

During a typical day in the past month, how often did your eyes look or feel excessively watery?(Required)
This field is hidden when viewing the form