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Rain Intake Quiz 1
HIPAA
Compliance
1
What’s the biggest issue you’re experiencing with your eyes?
Dry, gritty, or sandy feeling
Pain, burning or stinging
Red or irritated appearance
Regular eye drops wearing off too fast
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2
What’s your biggest goal for your eyes? (Choose as many as you like.)
I want to feel comfortable all day
I want my eyes to look clear and healthy
I want long-term relief, not just quick fixes
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3
How often do you currently use eye drops?
Daily (once or twice)
Multiple times per day
Occasionally, only when it’s bad
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4
Are your eyes ever… (Choose as many as you like.)
Painfully dry or gritty
Red and inflamed for no clear reason
Sensitive to wind or light
Always dry, no matter what I try
None of these
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5
Are you interested in any other clean eye health solutions? (Choose as many as you like.)
Lubricating eye drops (preservative-free)
Soothing heated eye masks
Vision support vitamins
Moisturizing eye cream for eye appearance
Not sure yet
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