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. How often do you experience any of these symptoms? Choose the applicable answer.Your Full Name*Headaches*1 - Never2 - Rarely3 - Sometimes4 - Very Often5 - AlwaysStiffness/pain in neck/shoulders*1 - Never2 - Rarely3 - Sometimes4 - Very Often5 - AlwaysDiscomfort with computer use*1 - Never2 - Rarely3 - Sometimes4 - Very Often5 - AlwaysTired Eyes*1 - Never2 - Rarely3 - Sometimes4 - Very Often5 - AlwaysDry Eye Sensation*1 - Never2 - Rarely3 - Sometimes4 - Very Often5 - AlwaysLight Sensitivity*1 - Never2 - Rarely3 - Sometimes4 - Very Often5 - AlwaysDizziness*1 - Never2 - Rarely3 - Sometimes4 - Very Often5 - AlwaysAdditional NotesAny additional notes you'd like to addEmailThis field is for validation purposes and should be left unchanged.