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Filling out the Speed Questionnaire and submitting to our office will help us determine how the Southern Eye Group Dry Eye Clinic can be of most help to you.
Report the Frequency of your symptoms by checking the appropriate box.
0 = Never
1 = Sometimes
2 = Often
3 = Constant
Report the Severity of your symptoms using the rating list below.
0 = No Problems
1 = Tolerable - not perfect, but not uncomfortable
2 = Uncomfortable - irritating, but does not interfere with my day
3 = Bothersome - irritating and interferes with my day
4 = Intolerable - unable to perform daily tasks
Call 251-990-3937 and schedule a Dry Eye Consultation todayor book an appointment online.