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Fraser Eye Care Center
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Dry Eye Online Self Evaluation

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Fraser Eye / Dry Eyes / Dry Eye Online Self Evaluation

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Dry Eye Self Evaluation

Q1: I experience the following: (check all that apply)*(Required)
Q2: I use artificial tears (also known as lubricating eye drops):*(Required)
Q3: I have been using artificial tears for:*(Required)
Q4. I have the following risk factors: (check all that apply)*(Required)
Q5: Treatment for Dry Eyes you have attempted include: (check all that apply)*(Required)
Q6: My dailiy activities are affected by my Dry Eyes: (check all that apply)*(Required)
Q7. How did you hear about us?: (check all that apply)*(Required)
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