See & Be Seen Eyecare
171 E Liberty St #136 Toronto ON M6K 3P6 (416) 516-2020
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416-516-2020

New Patients Form Hero

Dry Eye Patient Form

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  • Dry Eye Disease is the most frequent reason that patients visit eye doctors. We are concerned that you may be suffering with this condition as well. Therefore, we ask that you take a few moments and thoughtfully complete the questionnaire below. Report the SEVERITY of your symptoms using the ratings list below: 0 = No problems 1 = Tolerable - not perfect but not uncomfortable 2 = Uncomfortable – irritating but does not interfere with my day 3 = Bothersome – irritating and interferes with my day 4 = Intolerable – unable to perform my daily tasks
  • Report the FREQUENCY of your symptoms using the ratings list below: 0 = Never 1 = Sometimes 2 = Often 3 = Constant

Come Visit Us

See & Be Seen Eyecare

#136 - 171 East Liberty Street
Toronto, ON M6K 3P6

Contact Information

  • Dr Ritesh Patel, OD
  • Dr Alvin Yang, OD
  • Monday 10 AM - 6 PM
  • Tuesday 11 AM - 7 PM
  • Wednesday 11 AM - 7 PM
  • Thursday 12 PM - 8 PM
  • Friday 10 AM - 6 PM
  • Saturday 10 AM - 5 PM
  • Sunday Closed

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