1. How often do you have redness?
   Never Sometimes
   Frequently Always
2. How often do you have sandy or gritty sensation?
   Never Sometimes
   Frequently Always
3. How often do you have itching?
   Never Sometimes
   Frequently Always
4. How often do you have excess watering?
   Never Sometimes
   Frequently Always
5. How often do you have burning?
   Never Sometimes
   Frequently Always
6. How often do you have blurred vision?
   Never Sometimes
   Frequently Always
7. Are your eyes sensitive to light?
   Never Sometimes
   Frequently Always
8. Are your eyes sensitive to wind?
   Never Sometimes
   Frequently Always
9. Are your eyes sensitive to contact lenses?
   Never Sometimes
   Frequently Always
10. How often do you use redness reducing eye drops?
    Never Sometimes
    Frequently Always
11. How often do you use artificial tear drops?
    Never Sometimes
    Frequently Always
12. Average daily computer time hours?
    0 Hrs 1-2 Hrs
    2-4 Hrs Over 4 Hrs
13. Do you experience contact lens discomfort?
    Yes No
14. Do you get eyestrain?
    Yes No
15. Do you blink your eyes excessively?
    Yes No

*If you scored 15 you may have dry eyes. Please call our office for an evaluation.