Family Eyecare Center

Directions: For each of the following questions, please check the answer that best describes your situation. If you wear glasses or contact lenses, answer the questions assuming that you are wearing them.

Always - Everyday
Frequently - At least 1 time/week
Occasionally - Less than 1 time/week
Never

On an average day, how much are you bothered by the 8 symptoms listed below? (Rate each symptom from 0 to 10, where 10 is the worst it could be and where 0 means you have none of that symptom.