For the Standardized Patient Evaluation of Eye Dryness (SPEED) Questionnaire, please answer the following questions by checking the box that best represents your answer. Select only one answer per question.
Report the FREQUENCY of your symptoms using the rating list below:(0 = Never, 1 = Sometimes, 2 = Often, 3 = Constant)
Dryness, Grittiness, or Scratchiness
Soreness or Irritation
Burning or Watering
Report the SEVERITY of your symptoms using the rating list below:(0 = No Problems, 1 = Tolerable, 2 = Uncomfortable, 3 = Bothersome, 4 = Intolerable)
Dryness, Grittiness or Scratchiness
Do you use eye drops for lubrication? If yes, how often?
Please list your symptoms and any other additional comments
All EyeCare Services
In case of an after-hours eye emergency, please call (913) 261-8327 and follow the emergency prompts.
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