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Home » Eye Care Services » Dry Eye » DEQ-5 Questionnaire

DEQ-5 Questionnaire

Name: Sheridan Optometric Centre
Address: 103A-2155 Leanne Boulevard, Mississauga, ON, L5K 2K8, CA
Telephone: 905-822-3698
Price range: $000 - $300

Please answer the following questions by checking the box that best represents your answer. Select only one answer per question.

1. Do you experience EYE DISCOMFORT?
a. During a typical day in the past month, how often did your eyes feel discomfort?*
- Never
- Rarely
- Sometimes
- Frequently
- Constantly
b. When your eyes felt discomfort, how intense was this feeling of discomfort at the end of the day, within two hours of going to bed?*
- Never
- Rarely
- Sometimes
- Frequently
- Constantly
2. Do you experience EYE DRYNESS?
a. During a typical day in the past month, how often did your eyes feel dry?*
- Never
- Rarely
- Sometimes
- Frequently
- Constantly
b. When your eyes felt dry, how intense was this feeling of dryness at the end of the day, within two hours of going to bed?*
- Never
- Rarely
- Sometimes
- Frequently
- Constantly
3. Do you have WATERY EYES?
During a typical day in the past month, how often did your eyes look or feel excessively watery?*
- Never
- Rarely
- Sometimes
- Frequently
- Constantly
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Monday: 9:00 AM - 6:00 PM
Tuesday: 9:00 AM - 7:30 PM
Wednesday: 9:00 AM - 6:00 PM
Thursday: 9:00 AM - 6:00 PM
Friday: 9:00 AM - 5:00 PM
Saturday: 9:00 AM - 1:00 PM
Sunday: Closed

Extended hours available by request. Entry is by appointment only.

Phone: 905-822-3698

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Hours & Directions

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Sheridan Optometric Centre
103A-2155 Leanne Boulevard
Mississauga, ON L5K 2K8
Phone: 905-822-3698
https://www.sheridanoptometry.com

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DEQ-5 Questionnaire

1. Do you experience EYE DISCOMFORT?

2. Do you experience EYE DRYNESS?

3. Do you have WATERY EYES?

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