020 7636 6080
Dry Eye Syndrome
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Intense Pulsed Light
Low Level Light Therapy
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Get advice on your questionnaire results
Contact us
020 7636 6080
We're open:
Monday 9:00 am - 5:00 pm
Tuesday 8:45 am - 5:00 pm
Wednesday 9:00 am - 5:00 pm
Thursday 9:00 am - 5:00 pm
Friday 9:00 am - 5:00 pm
Dry eye questionnaire
Step
1
of
15
6%
Name
(Required)
First
Last
Phone
(Required)
Email
(Required)
How often have your eyes felt sensitive to light?
(Required)
All of the time
Most of the time
Half of the time
Some of the time
None of the time
How often have your eyes felt sensitive to light?
(Required)
All of the time
Most of the time
Half of the time
Some of the time
None of the time
How often have your eyes felt gritty?
(Required)
All of the time
Most of the time
Half of the time
Some of the time
None of the time
How often have you experienced blurred vision?
(Required)
All of the time
Most of the time
Half of the time
Some of the time
None of the time
How often have you experienced poor vision?
(Required)
All of the time
Most of the time
Half of the time
Some of the time
None of the time
Have problems with your eyes affected you when READING?
(Required)
All of the time
Most of the time
Half of the time
Some of the time
None of the time
How often have your eyes felt painful or sore?
(Required)
All of the time
Most of the time
Half of the time
Some of the time
None of the time
Have problems with your eyes affected you when USING A COMPUTER?
(Required)
All of the time
Most of the time
Half of the time
Some of the time
None of the time
Have problems with your eyes affected you when WATCHING TV?
(Required)
All of the time
Most of the time
Half of the time
Some of the time
None of the time
Have problems with your eyes affected you when DRIVING AT NIGHT?
(Required)
All of the time
Most of the time
Half of the time
Some of the time
None of the time
Have your eyes felt uncomfortable in WINDY CONDITIONS?
(Required)
All of the time
Most of the time
Half of the time
Some of the time
None of the time
Have your eyes felt uncomfortable in places or areas that are AIR CONDITIONED?
(Required)
All of the time
Most of the time
Half of the time
Some of the time
None of the time
Have your eyes felt uncomfortable in places or areas with LOW HUMIDITY (very dry)?
(Required)
All of the time
Most of the time
Half of the time
Some of the time
None of the time
Have your eyes been ITCHY?
(Required)
All of the time
Most of the time
Half of the time
Some of the time
None of the time
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Score
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