Complete Eye Exam Pre-Appointment Steps: Complete these 2 easy steps for a smooth check-in for your appointment STEP 1 : Dry Eye Questionnaire Full Name* Email Address* Do You ever experience any of these eye-related symptoms? Dryness, Burning, Tearing, Redness, Itching, Fatique, Scratchy or Gritty Sensation, ItchingIf YES please answer the following five questions and rate your symptoms based on a scale of 0-4 0 = Never 1 = Seasonally 2 = Sometimes 3 = Often 4 = Constantly1. My eyes are Dry, Gritty and Scratchy* 0 1 2 3 4 2. My eyes are sore and irritated* 0 1 2 3 4 3. My eyes burn or water* 0 1 2 3 4 4. I experience eye fatigue* 0 1 2 3 4 5. My eyes are red* 0 1 2 3 4 Are you interested in contact lenses?* YES NO Do you currently wear contact lenses?* YES NO Are they comfortable?* YES NO N/A What do you wish was better about your contact lenses?* Distance Vision Near Vision Comfort Length of wear N/A
