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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