Dry Eye Questionnaire

Name: Belill Eye Care, PLC
Address: 5092 West Vienna Rd, Suite I, Clio, MI, 48420-2803, US
Telephone: (810) 564-2000
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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Belill Eye Care, PLC

Contact Details

Phone: (810) 564-2000
Fax: (810) 564-2226
Email: belilleyecare@gmail.com
(Do not send personal health information by email.)

Address

5092 West Vienna Rd, Suite I
Clio, MI 48420-2803

Directions

In Creek's Edge Plaza, located across the street from Walmart on M57, West of Vienna Road.

Hours

Monday: 9:00 AM - 5:00 PM
Tuesday: 9:00 AM - 5:00 PM
Wednesday: 9:00 AM - 5:00 PM
Thursday: 9:00 AM - 7:00 PM
Friday: 9:00 AM - 5:00 PM
Saturday: Closed
Sunday: Closed

Payment Information

We Accept:

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Belill Eye Care, PLC - Located at 5092 West Vienna Rd, Suite I, Clio, MI , 48420-2803. Phone: (810) 564-2000 . https://www.belilleyecare.com

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1. Do you experience EYE DISCOMFORT?

2. Do you experience EYE DRYNESS?

3. Do you have WATERY EYES?

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Belill Eye Care, PLC