EVALUATE YOURSELF Do you suffer from burning, itching or gritty eyes?(Required) Yes No How often?(Required) Rarely Once a week or less Several times a week Every day Do you suffer from red, teary or painful eyes?(Required) Yes No How often?(Required) Rarely Once a week or less Several times a week All the time Do you suffer from tired eyes, unstable/blurry vision or light sensitivity?(Required) Yes No How often ?(Required) Rarely Once a week or less Several times a week All the time Does your eye situation limit you?(Required) Yes No How often ?(Required) Specific activities (e.g., reading, driving at night, watching TV, on a computer/smartphone/tablet) Most activities All the time Do you use artificial tears?(Required) Yes No How often ?(Required) Never Depends on the weather Several times a week Every day HiddenYour Score schedule a dry eye evaluationYou don't have dry eye, but during your next eye exam, Dr. Schwartz will still assess your eye health to see how we can help you.Want to discuss your score? Leave us your info!Name First Last Phone Number