Office Hours

  • Monday 8:00am to 6:00pm
  • Tuesday 10:00am to 7:00pm
  • Wednesday 8:00am to 3:00pm
  • Thursday 10:00am to 7:00pm
  • Friday 8:00am to 3:00pm
  • Saturday 8:00am to 12:00pm
3027 English Rows Ave. Suite 209
Naperville, IL 60564
PHONE: 630.922.2661
EMAIL: contactus@englishrow...

Ocular Surface Disease Index (OSDI) Questionnaire

Please fill out this form as it is directly related to Dry Eye Treatment

Name
Date
MM slash DD slash YYYY

Please answer the following 12 questions.

Have you experienced any of the following in the past week?
1. Eyes that are sensitive to light?
2. Eyes that feel gritty?
3. Painful or Sore Eyes?
4. Blurred vision?
5. Poor vision?
Have you had problems with your eyes which limited you in performing any of the following during the last week?
6. Reading
7. Driving at night?
8. Working with a computer or bank ATM machine?
9. Watching TV?
Have your eyes felt uncomfortable in any of the following situations during the last week?
10. Windy Conditions?
11. Places or areas with low humidity (very dry)?
12. Areas that are air conditioned?