SPEED Questionnaire

Phone: <a class="ecp-phone-call-phone" href="tel:270-781-3937" style="text-decoration:none"> 270-781-3937
Fax: 270-783-3435

Date of Birth

How FREQUENTLY do you experience the following dry eye symptoms?

How SEVERE are your dry eye symptoms?

Tally up your scores!

If you scored:

0-5 you are experiencing mild dry eye symptoms

6-8 you are experiencing moderate dry eye symptoms (additional workup recommended)

9+ you are experiencing severe dry eye symptoms (additional workup strongly recommended)

If you have further questions or would like to schedule an additional dry eye workup, please call our office today at 270-781-3937.

How FREQUENTLY do you experience the following dry eye symptoms?

How SEVERE are your dry eye symptoms?

Precision Eye Care & Optical