Dry Eye Assessment

Dry Eye Questionnaire

Dry Eye Disease is the most frequent reason that patients visit eye doctors. We are concerned that you may be suffering with this condition as well. Therefore, we would ask that you take a few moments and thoughtfully complete the questionnaire below. Your information will be kept confidential. After completing the questionnaire, call (301) 670-1212 to set up a consultation with one of our dry eye specialists where your results will be analyzed. During your visit treatment options will be recommended with the goal of finding the fastest path towards relief. By submitting this form, I agree and consent to be contacted by an optometric technician/representative from Shady Grove Eye and Vision Care concerning the dry eye assessment.