Full Name *Email *Age *PhoneANSWER THE FOLLOWING QUESTIONS CLICKING ON THE DROPDOWN ARROWS. HAVE YOU EXPERIENCED ANY OF THE FOLLOWING DURING THE LAST WEEK: 1. Eyes that are sensitive to light? *All of the timeMost of the timeHalf of the timeSome of the timeNone of the time2. Eyes that feel gritty? *All of the timeMost of the timeHalf of the timeSome of the timeNone of the time3. Painful or sore eyes? *All of the timeMost of the timeHalf of the timeSome of the timeNone of the time4. Blurred vision? *All of the timeMost of the timeHalf of the timeSome of the timeNone of the time5. Poor vision? *All of the timeMost of the timeHalf of the timeSome of the timeNone of the timeHAVE PROBLEMS WITH YOUR EYES LIMITED YOU IN PERFORMING ANY OF THE FOLLOWING DURING THE LAST WEEK: 6. Reading? *All of the timeMost of the timeHalf of the timeSome of the timeNone of the timeN/A7. Driving at night? *All of the timeMost of the timeHalf of the timeSome of the timeNone of the timeN/A8. Working with a computer or bank machine (ATM)? *All of the timeMost of the timeHalf of the timeSome of the timeNone of the timeN/A9. Watching TV? *All of the timeMost of the timeHalf of the timeSome of the timeNone of the timeN/AHAVE YOUR EYES FELT UNCOMFORTABLE IN ANY OF THE FOLLOWING SITUATIONS DURING THE LAST WEEK: 10. Windy conditions? *All of the timeMost of the timeHalf of the timeSome of the timeNone of the timeN/A11. Places or areas with low humidity (very dry)? *All of the timeMost of the timeHalf of the timeSome of the timeNone of the timeN/A12. Areas that are air conditioned? *All of the timeMost of the timeHalf of the timeSome of the timeNone of the timeN/ASubmit
