Dry Eye Self-Evaluation

Dry Eye Disease is one of the most frequent reason that patients visit eye doctors. We are concerned that you may be suffering with this condition as well.  Please complete this dry eye disease self-evaluation to determine if you might be suffering from dry eye.

Report the FREQUENCY of symptoms you are experiencing using the following numbering system:

0 = Never, 1 = Sometimes, 2 = Often, 3 = Constant

  • Contact Information


If you have checked any of the above boxes, you may have dry eye disease. Want dry eye relief? Come to our dry eye center of excellence. To schedule an appointment with a Boling Vision Center dry eye expert, call 1.800.283.8393 or request an online appointment.