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Vision Therapy
Myopia Management
Advanced Services
Eye Care Services
- Comprehensive Eye Exams
- Contact Lens Exams
Eyeglasses
Contact Lenses

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We're in Centerville Plaza on Hwy 5 next to Home Depot and Burger King

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About Us
Vision Therapy
Myopia Management
Advanced Services
Eye Care Services
- Comprehensive Eye Exams
- Contact Lens Exams
Eyeglasses
Contact Lenses

About Us
Vision Therapy
Myopia Management
Advanced Services
Eye Care Services
- Comprehensive Eye Exams
- Contact Lens Exams
Eyeglasses
Contact Lenses

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
Score
Your eyes are Normal
You may have Dry Eye Disease
You may have Sjogren's Disease and/or Dry Eye Disease
Want to discuss your score? Leave us your info!
Our team will contact you to discuss your results within 24-48 business hours. You can also call the office and ask them to check up your results as well.
Name*
First Last
Email*
Phone*

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Eye Center of Murphy

213 N. Murphy Road, Suite 100
Murphy, TX 75094

Phone: (972)-429-9011
Fax: 469-543-2293

Monday: 9:00 AM - 6:00 PM
Tuesday: 9:00 AM - 6:00 PM
Wednesday: 9:00 AM - 6:00 PM
Thursday: 9:00 AM - 6:00 PM
Friday: 9:00 AM - 4:00 PM
Saturday: Closed
Sunday: Closed

Wylie Eye Center

130 N Ballard Ave
Wylie, TX 75098

Phone: (972) 429-9090
Fax: 972-429-7676

Monday: 9:00 AM - 6:00 PM
Tuesday: 9:00 AM - 6:00 PM
Wednesday: 9:00 AM - 6:00 PM
Thursday: 9:00 AM - 6:00 PM
Friday: 9:00 AM - 4:00 PM
Saturday: 9:00 AM - 1:00 PM
Sunday: Closed

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Contact Us
What’s New
Disclaimer
Privacy Policy

Schedule Appointment

Wylie Eye Center

Eye Center of Murphy

Fax:
Wylie: 972-429-7676
Murphy: 469-543-2293

Speak Field

Wylie Eye Center
130 N Ballard Ave
Wylie, TX 75098
Phone: (972) 429-9090
https://www.murphy-eye.com

Eye Center of Murphy
213 N. Murphy Road, Suite 100
Murphy, TX 75094
Phone: (972)-429-9011
https://www.murphy-eye.com

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