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Home » Questionnaires and Forms » Neurolens Index Questionnaire

Neurolens Index Questionnaire

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Neurolens Lifestyle Index

This questionnaire is meant to help your doctor 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.

Headaches of any severity each week, usually getting worse later in the day(Required)
Stiffness / pain in neck / shoulders when you work at a computer or read(Required)
Discomfort with Computer Use in your eyes (redness, burning) after long hours looking at the screen(Required)
Tired Eyes with increasing feeling of eye fatigue throughout the day(Required)
Dry Eye Sensation feeling progressively more gritty/sandy while working at computer or reading(Required)
Light Sensitivity especially with brighter, stronger lights like fluorescents or headlights(Required)
Dizziness or an experience like motion sickness or vertigo(Required)
Name