Symptom Survey

  Parent Symptom Survey Symptom Survey Symptom Survey (CISS) (for Patients ≥8 Years of Age) Name _______________________________________ Date ______________________ Please answer the following questions about how your eyes feel when reading or doing close work. (For patients ≤12 years of age, the intern/doctor should read the question to the patient.) Symptom: Never Infrequently – Sometimes…

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