SPEED Questionnaire Name First Last Date of Birth MM slash DD slash YYYY Sex Male Female How FREQUENTLY do you experience the following dry eye symptoms?Dryness, Grittiness, or Scratchiness(Required) (0) Never (1) Sometimes (2) Often (3) Constant Soreness or Irritation(Required) (0) Never (1) Sometimes (2) Often (3) Constant Burning or Watering(Required) (0) Never (1) Sometimes (2) Often (3) Constant Eye Fatique(Required) (0) Never (1) Sometimes (2) Often (3) Constant How SEVERE are your dry eye symptoms?Dryness, Grittiness, or Scratchiness(Required) (0) No Problems (1) Tolerable (2) Uncomfortable (3) Bothersome (4) Intolerable Soreness or Irritation(Required) (0) No Problems (1) Tolerable (2) Uncomfortable (3) Bothersome (4) Intolerable Burning or Watering(Required) (0) No Problems (1) Tolerable (2) Uncomfortable (3) Bothersome (4) Intolerable Eye Fatique(Required) (0) No Problems (1) Tolerable (2) Uncomfortable (3) Bothersome (4) Intolerable 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.