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Neurolens Survey

Neurolens Survey

This questionnaire is meant to help Dr. Lauretta understand what you're experiencing on a regular basis - whether it's caused by your eyes, posture, stress, etc. Your responses will help make sure you receive the best care possible.

Name(Required)
How often do you experience headaches? Of any Severity each week and usually getting worse later in the day.(Required)
How often do you experience stiffness, neck or shoulder pain when you work on a computer or read?(Required)
How often do you experience discomfort at a computer such as redness, dryness or burning after long hours looking at a screen?(Required)
How often do you experience eye strain, tired eyes that get worse later in the day?(Required)
How often do you experience an increase in dry eye symptoms while working on computer or reading?(Required)
How often do you experience light sensitivity especially with brighter florescent lights and headlights?(Required)
How often do you experience motion sickness, dizziness or vertigo?(Required)
Consent(Required)

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