Dry Eye Questionnaire Name* First Last Phone*Email 1. Questions about EYE DISCOMFORTa. During a typical day in the past month, how often did your eyes feel discomfort?*NeverRarelySometimesFrequentlyConstantlyb. 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?*0 - Never have it1 - Not at all intense2345 - Very intense2. Questions about EYE DRYNESSa. During a typical day in the past month, how often did your eyes feel dry?*NeverRarelySometimesFrequentlyConstantlyb. 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?*0 - Never have it1 - Not at all intense2345 - Very intense3. Question about WATERY EYESDuring a typical day in the past month, how often did your eyes look or feel excessively watery?*NeverRarelySometimesFrequentlyConstantlyScore