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Tell us about your Dry Eye

"Here's my full story."

Please answer the questions below

1. How long have you had dry eye?
2. Which eye bothers you more?
3. What eye drops have you used to address your dry eye?
4. Are either of your eyes:
5. Do your eyes feel like there's:
6. Have you had a history of eye problems such as:
7. Has a family member had a history of eye problems such as:
8. In the past 2 months (60 days) have you had any type of eye surgery?
9. Do you have a history of autoimmune diseases?
10. Do you have a family member with a history of autoimmune diseases?
11. Do you or a family member currently have or ever had:
13. Do you have intolerance of reactions to personal care products such as:
15. Was the eye exam a complete exam with dilation of your pupils?
16. Was the exam provided by a:
Click here to upload Eye Exam
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