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Dry Eyes Self Evaluation Quiz

Do you have Dry Eye? The quiz below is a great start to finding out your Ocular Surface Disease Index (OSDI).

Simply fill in the contact information, answer all the questions and click “submit” and one of our Dry Eye specialists will be in touch. We invite you to call (757) 742-3902 now to schedule your consultation and learn about your options.

do or do not , there is no try

First Name:

Last Name:

Phone:

Email:

Gender

Male

Female

Age

18-30

31-45

46-59

60+

Do you regularly experience any of the following symptoms? (Check all that apply)

Blurred vision

Gritty eyes

Light sensitivity

Sore or painful eyes

Excessive tearing

Do any of the above symptoms affect the following? (Check all that apply)

Driving

Reading

Watching TV

Using computer, smartphone, or tablet

Are you a current patient at Virginia Eye Consultants?

Yes

No

When is the best time to contact you?

Morning

Afternoon

Evening

How did you hear about us?

Email me about news & special offers

By completing this form and providing your email address, you are opting in to receive email communications from Virginia Eye Consultants. You may choose to opt-out of future email communications at any time.

The doctors at Virginia Eye Consultants have either authored or reviewed the content on this site.

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