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Dry Eye Self Test
Treat your dry eye disease, not just your symptoms.
Piedmont EyeCare is one of the only Dry Eye Centers of Excellence in Charlotte.
Take the Dry Eye Self-Test
Name
*
First
Last
Email
*
Phone
*
During a typical day in the past month, how often did your eyes feel discomfort?
*
Never
Rarely
Sometimes
Frequently
Constantly
When your eyes felt discomfort, how intense was the discomfort at the end of the day (within two hours of going to bed)?
*
Never Had It
Not Intense
A Little Intense
Somewhat Intense
Quite Intense
Very Intense
During the past month, how often did your eyes feel dry?
*
Never
Rarely
Sometimes
Frequently
Constantly
When your eyes felt dry, how intense was the dryness at the end of the day (within two hours of going to bed)?
*
Never Had It
Not Intense
A Little Intense
Somewhat Intense
Quite Intense
Very Intense
During the past month, how often did your eyes look or feel excessively watery?
*
Never
Rarely
Sometimes
Frequently
Constantly
