Skip to main content

5885 San Felipe St #550, Houston, TX 77057

Hours & Location
Our Eye Doctors
Advanced Services
- Dry Eye
- Myopia Management
Eye Care Services
Eyeglasses
Contact Lenses
Insurance

MENU

Hours & Location
Our Eye Doctors
Advanced Services
- Dry Eye
- Myopia Management
Eye Care Services
Eyeglasses
Contact Lenses
Insurance

Home » Advanced Services » Dry Eye » 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?*
- Never
- Rarely
- Sometimes
- Frequently
- Constantly
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?*
- Never
- Rarely
- Sometimes
- Frequently
- Constantly
2. Do you experience EYE DRYNESS?
a. During a typical day in the past month, how often did your eyes feel dry?*
- Never
- Rarely
- Sometimes
- Frequently
- Constantly
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?*
- Never
- Rarely
- Sometimes
- Frequently
- Constantly
3. Do you have WATERY EYES?
During a typical day in the past month, how often did your eyes look or feel excessively watery?*
- Never
- Rarely
- Sometimes
- Frequently
- Constantly
Score
You may have Sjogren's Disease and/or Dry Eye Disease
You may have Dry Eye Disease
Your eyes are Normal
Want to discuss your score? Leave us your info!
Our team will contact you to discuss your results within 24-48 business hours. You can also call the office and ask them to check up your results as well.
Name*
First Last
Email*
Phone*

Search:

Schedule An Appointment

Order Contacts Online

ProOptix Eye Care

5885 San Felipe St #550
Houston, TX 77057

Phone: 713-360-7095

Monday: 10AM - 7PM
Tuesday: 10AM - 7PM
Wednesday: 10AM - 7PM
Thursday: 10AM - 7PM
Friday: 10AM - 5PM
Saturday: 9AM - 2PM
Sunday: Closed

Home
Contact Us
Patient Forms
What’s New
Disclaimer
Privacy Policy

Home
Contact Us
Patient Forms
What’s New
Disclaimer
Privacy Policy

Schedule Appointment

Speak Field

ProOptix Eye Care - Located at 5885 San Felipe St #550, Houston, TX 77057. Phone: 713-360-7095 . https://www.prooptixeyecare.com

Powered by EyeCarePro.com
The materials and articles contained on this website are copyrighted and protected under Title 17 of the United States Code
Email Accessibility | Website Accessibility | Sitemap | Privacy | Disclaimer | Login