SPEED Questionnaire

SPEED Questionnaire for Dry Eye Diseases at Newport Mesa Optometry

Welcome to Newport Mesa Optometry, your trusted eye care partner in Costa Mesa, CA. We are dedicated to providing efficient and personalized solutions for your eye health needs.


What is the SPEED Questionnaire for Dry Eye Diseases?

Our SPEED (Standard Patient Evaluation of Eye Dryness) Questionnaire is designed to assess and optimize the speed and efficiency of various processes related to dry eye diseases within our practice.


Once you submit your questionnaire, our dedicated team will promptly review your responses and reach out to you. We are committed to finding the best solutions for your dry eye concerns and enhancing your overall eye care experience.


Get Started - Fill Out the Assessment Below:

Modified SPEED Questionnaire

How FREQUENTLY do you experience the following dry eye symptoms?
(0 = Never, 1 = Sometimes, 2 = Often, 3 = Constant)

Dryness, Grittiness, or Scratchiness

Soreness or Irritation

Burning or Watering

Eye Fatigue

How SEVERE are your dry eye symptoms?
0 = No Problems
1 = Tolerable - Not perfect but not uncomfortable
2 = Uncomfortable - Irratating but does not interfere with my day
3 = Bothersome - Irritating and interferes with my day
4 = Intolerable - unable to perform my daily task

Dryness, Grittiness or Scratchiness

Soreness or Irritation

Burning or Watering

Eye Fatigue

Does your face flush after drinking alcohol or exercising?

Does you have trouble seeing at night while driving?

Thank you for completing the SPEED Questionnaire!
This assessment is your first step toward finding relief from dry eye.

Your Score: