DRY EYE TEST Book an Appointment FREE MYOPIA CONSULT Dry Eye Test - SPEED Questionnaire™ Complete the Standardized Patient Evaluation of Eye Dryness (SPEEDTM) and fill out your information to see the results! Symptoms you're experiencing and how often you experience them: 1. Dryness, Grittiness or Scratchiness*(Required) At this time Within past 72 hours Within past 3 months Not at this time Not within the past 72 hours 2. Soreness or Irritation*(Required) At this time Within past 72 hours Within past 3 months Not at this time Not within the past 72 hours 3. Burning or Watering*(Required) At this time Within past 72 hours Within past 3 months Not at this time Not within the past 72 hours 4. Eye Fatigue*(Required) At this time Within past 72 hours Within past 3 months Not at this time Not within the past 72 hours 5. How Frequently do you Experience your symptoms? 0=never, 1=Sometimes, 2=Often, 3=ConstantDryness Grittiness or Scratchiness*(Required) 0 1 2 3 Soreness or Irritation*(Required) 0 1 2 3 Burning or Watering*(Required) 0 1 2 3 Eye Fatigue*(Required) 0 1 2 3 6. How Frequently do you Experience your symptoms? 0=Not Severe, 1=Tolerable, 2=Uncomfortable, 3=Bothersome, 4=Intolerable Dryness Grittiness or Scratchiness*(Required) 0 1 2 3 4 Soreness or Irritation*(Required) 0 1 2 3 4 Burning or Watering*(Required) 0 1 2 3 4 Eye Fatigue*(Required) 0 1 2 3 4 Do you use eye drops for lubrication?*(Required) Yes No If yes, how often do you use eye drops?*(Required) Fill out your information below to receive your results: Patient Name*(Required) Phone Number*(Required)Email Address*(Required) New or Returning Patient*(Required) CAPTCHA 39277
