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About Us
- Hours & Location
- Our Eye Doctors
Vision Therapy
Myopia Management
Dry Eye
Scleral Lenses
Eye Care Services
Eyeglasses
Contact Lenses
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Home » Eye Care 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
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Lifetime Eyecare

6203 28 Ave NW
Edmonton, AB T6L 6K3

Phone: 780-462-7500
Email: info@lifetime-eyecare.ca
(Do not send personal health information by email.)

Monday: 9:00 AM - 5:00 PM
Tuesday: 12:00 PM - 8:00 PM
Wednesday: 12:00 PM - 8:00 PM
Thursday: 9:00 AM - 5:00 PM
Friday: 9:00 AM - 5:00 PM
Saturday: Closed
Sunday: Closed

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Lifetime Eyecare
6203 28 Ave NW
Edmonton, AB T6L 6K3
Phone: 780-462-7500
https://www.lifetime-eyecare.ca

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