Dry Eye Test (866) 306-1450 Book an APpointment Dry Eye Test – SPEED Questionnaire™ Complete the Standardized Patient Evaluation of Eye Dryness (SPEEDTM) and fill out your information to see the results! Symptoms you’re experiencing and how often you experience them: 1. Dryness, Grittiness or Scratchiness* At this time Within past 72 hours Withing past 3 months Not at this time Not within the past 72 hours Not within the past 72 hours 2. Soreness or Irritation* At this time Within past 72 hours Withing past 3 months Not at this time Not within the past 72 hours Not within the past 72 hours 3. Burning or Watering* At this time Within past 72 hours Withing past 3 months Not at this time Not within the past 72 hours Not within the past 72 hours 4. Eye Fatigue* At this time Within past 72 hours Withing past 3 months Not at this time Not within the past 72 hours Not within the past 72 hours 5. How Frequently do you Experience your symptoms? 0=never, 1=Sometimes, 2=Often, 3=ConstantDryness Grittiness or Scratchiness* 0 1 2 3 Soreness or Irritation* 0 1 2 3 Burning or Watering* 0 1 2 3 Eye Fatigue* 0 1 2 3 6. How severe are your symptoms?0=Not Severe, 1=Tolerable, 2=Uncomfortable, 3=Bothersome, 4=IntolerableDryness Grittiness or Scratchiness* 0 1 2 3 Soreness or Irritation* 0 1 2 3 Burning or Watering* 0 1 2 3 Eye Fatigue* 0 1 2 3 Do you use eye drops for lubrication? Yes No Untitled Fill out your information below to receive your results:Patient Name*(Required) Phone Number(Required)Email(Required) New or Returning Patient*(Required) CAPTCHA 50475
