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Just North of Horsetooth on Shields St. in Fort Collins, CO

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Home » TearScience LipiFlow » Dry Eye Form

Dry Eye Form

Please take a few minutes to complete the questionnaire below.

Dry Eye Form

  • Symptom Frequency - Describe the FREQUENCY of dry eye symptoms you are experiencing by selecting Never, Sometimes, Often or Constant below:

  • Symptom Severity - Describe the SEVERITY of your symptoms using the ratings list below:

  • Current Treatment

Protecting our Patients from Coronavirus

To our valued patients: We value the health and safety of our patients and staff above all else. To that end, we are following the CDC guidelines regarding the COVID-19 pandemic. We have made the difficult decision to significantly reduce our office hours and services to urgent/emergent eye care only effective immediately and until further notice. The limited office hours will be Monday through Friday 9 am to Noon. Thank you for your understanding. We will continue to monitor the situation and will update patients as the situation develops. Please call regarding contact lens and glasses needs, and we will do what we can to accommodate your situation. 970-490-2020

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PLEASE NOTE: Please visit this page for updated information on the coronavirus situation.