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About Us
Our Practice
Our Doctor
Testimonials
Procedures
Cataract Surgery
Cataract Self-Test
Book Cataract Consult
Custom LASIK
LASIK Pricing
Lasik Self-Test
Book LASIK Consult
EVO ICL
Refractive Lens Exchange
SMILE
Self-Tests
Lasik Self-Test
Cataract Self-Test
Blog
Patient Resources
Contact Lenses
Pricing & Insurance
Pay Bill
Contact Us
Schedule Appointment
Prior to your dry eye consultation with our doctors, we would appreciate you answering a few specific questions relating to your eyes and health.
Dry Eye Consultation (1)
What products have you used for your dry eyes?
*
Over the Counter Artificial Tears
Currently Using?
Y
N
Used in the Past?
Y
N
Was it helpful?
Y
N
Over the Counter Gel/ Ointment
Over the Counter Gel/ Ointment
Currently Using?
Y
N
Used in the Past?
Y
N
Was it helpful?
Y
N
Warm Compresses/ Mask
Warm Compresses/ Mask
Currently Using?
Y
N
Used in the Past?
Y
N
Was it helpful?
Y
N
Lid Scrubs/ Sprays
Lid Scrubs/ Sprays
Currently Using?
Y
N
Used in the Past?
Y
N
Was it helpful?
Y
N
Oral Vitamins
Oral Vitamins
Currently Using?
Y
N
Used in the Past?
Y
N
Was it helpful?
Y
N
Antibiotic Eye Drops
Antibiotic Eye Drops
Currently Using?
Y
N
Used in the Past?
Y
N
Was it helpful?
Y
N
Steroid Eye Drops
Steroid Eye Drops
Currently Using?
Y
N
Used in the Past?
Y
N
Was it helpful?
Y
N
Oral Antibiotics
Oral Antibiotics
Currently Using?
Y
N
Used in the Past?
Y
N
Was it helpful?
Y
N
Prescription Xiidra
Prescription Xiidra
Currently Using?
Y
N
Used in the Past?
Y
N
Was it helpful?
Y
N
Prescription Restasis
Prescription Restasis
Currently Using?
Y
N
Used in the Past?
Y
N
Was it helpful?
Y
N
Prescription Cequa
Prescription Cequa
Currently Using?
Y
N
Used in the Past?
Y
N
Was it helpful?
Y
N
Serum Tears
Serum Tears
Currently Using?
Y
N
Used in the Past?
Y
N
Was it helpful?
Y
N
Have you had any of the following procedures your eyes?
Punctal Pluges
Laser Vision Correction (LASIK, PRK, RK)
Intense Pulsed Light (IPL)
Lipiflow
Meibomian Gland Probing
Dry eye contact lenses (Prokera, Sclera, Zen)
Blepharoplasty/ eyelid lift
Permanent tattoo make-up
Do you use any of the following products?
Facial wrinkle cream
Daily facial wash
Facial serums
Facial Lotions / moisturizers
Eyelash growth enhancers
Eye make-up
Facial exfoliants
Make-up remover
Have you ever been diagnosed with any of the following?
Sjogrens
Acne
Graves’ Disease
Rosacea
Gum Disease
Multiple Sclerosis
Rheumatoid Arthritis
Lupus
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