Sex
  • Male
  • Female
  • I'd prefer not to say
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For the Standardized Patient Evaluation of Eye Dryness (SPEED) Questionnaire, please answer the following questions by checking the box that best represents your answer. Select only one answer per question.

1. Report the FREQUENCY of the following symptoms (if applicable) using the rating list below:

0 = Never

1 = Sometimes

2 = Often

3 = Constant

Dryness, Grittiness or Scrat...
  • 0
  • 1
  • 2
  • 3
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Soreness or Irritation
  • 0
  • 1
  • 2
  • 3
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  • List is empty.
Burning or Watering
  • 0
  • 1
  • 2
  • 3
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Eye Fatigue
  • 0
  • 1
  • 2
  • 3
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2. 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 my daily tasks

Dryness, Grittiness or Scrat...
  • 0
  • 1
  • 2
  • 3
  • 4
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Soreness or Irritation
  • 0
  • 1
  • 2
  • 3
  • 4
  • No elements found. Consider changing the search query.
  • List is empty.
Burning or Watering
  • 0
  • 1
  • 2
  • 3
  • 4
  • No elements found. Consider changing the search query.
  • List is empty.
Eye Fatigue
  • 0
  • 1
  • 2
  • 3
  • 4
  • No elements found. Consider changing the search query.
  • List is empty.
Do you use eye drops?
  • Yes
  • No
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  • List is empty.

For more information or to schedule an evaluation, please share your phone number or email with us. By submitting your phone number or email, you understand we may use them to contact you.

(702) 479-5222
1225 S FORT APACHE RD #145, LAS VEGAS, NV 89117

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