Lifestyle Index Survey:
This survey 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? Select one:

- You get headaches of any severity each week (even just a dull ache counts.)
- Your headaches tend to get worse later in the day.
- Your headaches are generally worse at work than they are at home or on the weekends.

Stiffness /pain in neck/ shoulders:*
- Your neck gets stiff and sore when you work at a computer or read (this might even be from your posture).
- You experience frequent tension in your head, neck or shoulders.
- You get frequent massages/Chiropractic adjustments.

Discomfort with computer use:*
- You feel like you are more productive at work in the morning vs. the afternoon.
- Your eyes get tired, burn, or get ready easily when you work at a computer for long hours.

Tired Eyes:*
- Your eyes feel fatigued at the end of a work day.
- Your eyes generally feel better in the morning compared to the end of the day.

Dry Eye Sensation:*
- Your eyes and/or contacts tend to dry out when you're working at a computer or reading.
- Your eyes progressively feel more dry/sandy/gritty as the day goes on.

Light Sensitivity:*
- Driving at night is difficult because of glare from headlights
- Fluorescent lights bother you in large spaces (grocery store, department store, etc.)

- Riding in a car gives you motion sickness.
- You sometimes feel a sensation of vertigo or disconnectedness from your environment.

Any additional comments about these symptoms?: