{"id":425,"date":"2023-02-21T20:14:37","date_gmt":"2023-02-21T20:14:37","guid":{"rendered":"https:\/\/uabmedicine.org\/blogs\/greyform\/?page_id=425"},"modified":"2023-02-21T20:14:37","modified_gmt":"2023-02-21T20:14:37","slug":"org-dry-eye-quiz","status":"publish","type":"page","link":"https:\/\/uabforms.hs.uab.edu\/blogs\/greyform\/index.php\/org-dry-eye-quiz\/","title":{"rendered":"ORG Dry Eye Quiz"},"content":{"rendered":"<script type=\"text\/javascript\">if(!gform){document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0});var gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),null==t&&(t=10),gform.hooks[o][n].push({tag:i,callable:r,priority:t})},doHook:function(o,n,r){if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[o][n]){var t,i=gform.hooks[o][n];i.sort(function(o,n){return o.priority-n.priority});for(var e=0;e<i.length;e++)\"function\"!=typeof(t=i[e].callable)&#038;&#038;(t=window[t]),\"action\"==o?t.apply(null,r):r[0]=t.apply(null,r)}if(\"filter\"==o)return r[0]},removeHook:function(o,n,r,t){if(null!=gform.hooks[o][n])for(var i=gform.hooks[o][n],e=i.length-1;0<=e;e--)null!=t&#038;&#038;t!=i[e].tag||null!=r&#038;&#038;r!=i[e].priority||i.splice(e,1)}}}<\/script>\n                <div class='gf_browser_gecko gform_wrapper gravity-theme' id='gform_wrapper_128' style='display:none'><div id='gf_128' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_128' id='gform_128'  action='\/blogs\/greyform\/index.php\/wp-json\/wp\/v2\/pages\/425#gf_128' novalidate>\n        <div id='gf_progressbar_wrapper_128' class='gf_progressbar_wrapper'>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>6<\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_16' style='width:16%;'><span>16%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform_body gform-body'><div id='gform_page_128_1' class='gform_page' >\n                                    <div class='gform_page_fields'><div id='gform_fields_128' class='gform_fields top_label form_sublabel_below description_below'><fieldset id=\"field_128_1\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible gquiz-field \"  data-field-class=\"gquiz-field\"><legend class='gfield_label gfield_label_before_complex'  >Do you experience the following dry eye symptoms? Select all that apply.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_128_1'><div class='gchoice gchoice_128_1_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_1.1' type='checkbox'  value='gquiz1b01d52af'  id='choice_128_1_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_128_1_1' id='label_128_1_1'>Dryness, Grittness or Scratchiness<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_128_1_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_1.2' type='checkbox'  value='gquiz15382ff22'  id='choice_128_1_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_128_1_2' id='label_128_1_2'>Soreness or Irritation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_128_1_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_1.3' type='checkbox'  value='gquiz1099c6594'  id='choice_128_1_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_128_1_3' id='label_128_1_3'>Burning or Watering<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_128_1_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_1.4' type='checkbox'  value='gquiz1a11836d8'  id='choice_128_1_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_128_1_4' id='label_128_1_4'>Eye Fatigue<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_128_2\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >How frequently do you experience dryness, grittness or scratchiness?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_128_2'>\n\t\t\t<div class='gchoice gchoice_128_2_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_2' type='radio' value='Never'  id='choice_128_2_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_2_0' id='label_128_2_0'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_2_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_2' type='radio' value='Sometimes'  id='choice_128_2_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_2_1' id='label_128_2_1'>Sometimes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_2_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_2' type='radio' value='Often'  id='choice_128_2_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_2_2' id='label_128_2_2'>Often<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_2_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_2' type='radio' value='Always'  id='choice_128_2_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_2_3' id='label_128_2_3'>Always<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_128_3\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >How frequently do you experience soreness or irritation?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_128_3'>\n\t\t\t<div class='gchoice gchoice_128_3_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='Never'  id='choice_128_3_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_3_0' id='label_128_3_0'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_3_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='Sometimes'  id='choice_128_3_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_3_1' id='label_128_3_1'>Sometimes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_3_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='Often'  id='choice_128_3_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_3_2' id='label_128_3_2'>Often<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_3_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='Always'  id='choice_128_3_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_3_3' id='label_128_3_3'>Always<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_128_4\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >How frequently do you experience burning or watering?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_128_4'>\n\t\t\t<div class='gchoice gchoice_128_4_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='Never'  id='choice_128_4_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_4_0' id='label_128_4_0'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_4_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='Sometimes'  id='choice_128_4_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_4_1' id='label_128_4_1'>Sometimes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_4_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='Often'  id='choice_128_4_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_4_2' id='label_128_4_2'>Often<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_4_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='Always'  id='choice_128_4_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_4_3' id='label_128_4_3'>Always<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_128_5\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >How frequently do you experience eye fatigue?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_128_5'>\n\t\t\t<div class='gchoice gchoice_128_5_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='Never'  id='choice_128_5_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_5_0' id='label_128_5_0'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_5_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='Sometimes'  id='choice_128_5_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_5_1' id='label_128_5_1'>Sometimes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_5_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='Often'  id='choice_128_5_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_5_2' id='label_128_5_2'>Often<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_5_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_5' type='radio' value='Always'  id='choice_128_5_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_5_3' id='label_128_5_3'>Always<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_128_34\" class=\"gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\" ><h2 style=\"text-align: center;\">Your results show that you have no dry eye symptoms<\/h2>\n<p><strong>Even though your results show you have no symptoms of dry eye, symptoms can come and go. Completing a thorough eye exam with a UAB Callahan Eye Hospital Ophthalmologist is the best way to prevent and protect your vision. <a href=\"https:\/\/www.uabmedicine.org\/appointment-callahan\" target=\"_new\">Click here<\/a> to schedule an appointment if you feel you have these symptoms, despite the results of this quiz. Or call <a href=\"tel:205-258-0034\">205.258.0034<\/a> to speak with our scheduling office.<\/strong><\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_128_6' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_128\").val(\"2\");  jQuery(\"#gform_128\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_128\").val(\"2\");  jQuery(\"#gform_128\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_128_2' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_128_2' class='gform_fields top_label form_sublabel_below description_below'><fieldset id=\"field_128_8\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label gfield_label_before_complex'  >How severe are your dry eye symptoms? Select all that apply.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox' id='input_128_8'><div class='gchoice gchoice_128_8_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.1' type='checkbox'  value='Dryness, Grittiness or Scratchiness'  id='choice_128_8_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_128_8_1' id='label_128_8_1'>Dryness, Grittiness or Scratchiness<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_128_8_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.2' type='checkbox'  value='Soreness or Irritation'  id='choice_128_8_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_128_8_2' id='label_128_8_2'>Soreness or Irritation<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_128_8_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.3' type='checkbox'  value='Burning or Watering'  id='choice_128_8_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_128_8_3' id='label_128_8_3'>Burning or Watering<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_128_8_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_8.4' type='checkbox'  value='Eye Fatigue'  id='choice_128_8_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_128_8_4' id='label_128_8_4'>Eye Fatigue<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_128_9\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >How severe is dryness. grittness or scratchiness?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_128_9'>\n\t\t\t<div class='gchoice gchoice_128_9_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='No problems'  id='choice_128_9_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_9_0' id='label_128_9_0'>No problems<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_9_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='Tolerable'  id='choice_128_9_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_9_1' id='label_128_9_1'>Tolerable<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_9_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='Uncomfortable (irritating but does not interfere with my day)'  id='choice_128_9_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_9_2' id='label_128_9_2'>Uncomfortable (irritating but does not interfere with my day)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_9_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='Bothersome (interferes with my day)'  id='choice_128_9_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_9_3' id='label_128_9_3'>Bothersome (interferes with my day)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_9_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='Intolerable (unable to perform daily tasks)'  id='choice_128_9_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_9_4' id='label_128_9_4'>Intolerable (unable to perform daily tasks)<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_128_10\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >How severe is soreness or irritation?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_128_10'>\n\t\t\t<div class='gchoice gchoice_128_10_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='No problems'  id='choice_128_10_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_10_0' id='label_128_10_0'>No problems<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_10_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Tolerable'  id='choice_128_10_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_10_1' id='label_128_10_1'>Tolerable<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_10_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Uncomfortable (irritating but does not interfere with my day)'  id='choice_128_10_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_10_2' id='label_128_10_2'>Uncomfortable (irritating but does not interfere with my day)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_10_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Bothersome (interferes with my day)'  id='choice_128_10_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_10_3' id='label_128_10_3'>Bothersome (interferes with my day)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_10_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_10' type='radio' value='Intolerable (unable to perform daily tasks)'  id='choice_128_10_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_10_4' id='label_128_10_4'>Intolerable (unable to perform daily tasks)<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_128_11\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >How severe is burning or watering?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_128_11'>\n\t\t\t<div class='gchoice gchoice_128_11_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='No problems'  id='choice_128_11_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_11_0' id='label_128_11_0'>No problems<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_11_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='Tolerable'  id='choice_128_11_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_11_1' id='label_128_11_1'>Tolerable<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_11_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='Uncomfortable (irritating but does not interfere with my day)'  id='choice_128_11_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_11_2' id='label_128_11_2'>Uncomfortable (irritating but does not interfere with my day)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_11_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='Bothersome (interferes with my day)'  id='choice_128_11_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_11_3' id='label_128_11_3'>Bothersome (interferes with my day)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_11_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='Intolerable (unable to perform daily tasks)'  id='choice_128_11_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_11_4' id='label_128_11_4'>Intolerable (unable to perform daily tasks)<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_128_12\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >How severe is eye fatigue?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_128_12'>\n\t\t\t<div class='gchoice gchoice_128_12_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='No problems'  id='choice_128_12_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_12_0' id='label_128_12_0'>No problems<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_12_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Tolerable'  id='choice_128_12_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_12_1' id='label_128_12_1'>Tolerable<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_12_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Uncomfortable (irritating but does not interfere with my day)'  id='choice_128_12_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_12_2' id='label_128_12_2'>Uncomfortable (irritating but does not interfere with my day)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_12_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Bothersome (interferes with my day)'  id='choice_128_12_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_12_3' id='label_128_12_3'>Bothersome (interferes with my day)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_12_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Intolerable (unable to perform daily tasks)'  id='choice_128_12_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_12_4' id='label_128_12_4'>Intolerable (unable to perform daily tasks)<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_128_35\" class=\"gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\" ><h2 style=\"text-align: center;\">Your results show that you have no dry eye symptoms<\/h2>\n<p><strong>Even though your results show you have no symptoms of dry eye, symptoms can come and go. Completing a thorough eye exam with a UAB Callahan Eye Hospital Ophthalmologist is the best way to prevent and protect your vision. <a href=\"https:\/\/www.uabmedicine.org\/appointment-callahan\" target=\"_new\">Click here<\/a> to schedule an appointment if you feel you have these symptoms, despite the results of this quiz. Or call <a href=\"tel:205-258-0034\">205.258.0034<\/a> to speak with our scheduling office.<\/strong><\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_128_13' class='gform_previous_button button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_128\").val(\"1\");  jQuery(\"#gform_128\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_128\").val(\"1\");  jQuery(\"#gform_128\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_128_13' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_128\").val(\"3\");  jQuery(\"#gform_128\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_128\").val(\"3\");  jQuery(\"#gform_128\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_128_3' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_128_3' class='gform_fields top_label form_sublabel_below description_below'><fieldset id=\"field_128_14\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >When have you experienced these symptoms?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_128_14'>\n\t\t\t<div class='gchoice gchoice_128_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Never'  id='choice_128_14_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_14_0' id='label_128_14_0'>Never<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Today'  id='choice_128_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_14_1' id='label_128_14_1'>Today<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_14_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Within the past 72 hours'  id='choice_128_14_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_14_2' id='label_128_14_2'>Within the past 72 hours<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_14_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Within the past 3 months'  id='choice_128_14_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_14_3' id='label_128_14_3'>Within the past 3 months<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_128_36\" class=\"gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\" ><h2 style=\"text-align: center;\">Your results show that you have no dry eye symptoms<\/h2>\n<p><strong>Even though your results show you have no symptoms of dry eye, symptoms can come and go. Completing a thorough eye exam with a UAB Callahan Eye Hospital Ophthalmologist is the best way to prevent and protect your vision. <a href=\"https:\/\/www.uabmedicine.org\/appointment-callahan\" target=\"_new\">Click here<\/a> to schedule an appointment if you feel you have these symptoms, despite the results of this quiz. Or call <a href=\"tel:205-258-0034\">205.258.0034<\/a> to speak with our scheduling office.<\/strong><\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_128_16' class='gform_previous_button button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_128\").val(\"2\");  jQuery(\"#gform_128\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_128\").val(\"2\");  jQuery(\"#gform_128\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_128_16' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_128\").val(\"4\");  jQuery(\"#gform_128\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_128\").val(\"4\");  jQuery(\"#gform_128\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_128_4' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_128_4' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_128_37\" class=\"gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\" ><h2 style=\"text-align: center;\">Your results show that you have no dry eye symptoms<\/h2>\n<p><strong>Even though your results show you have no symptoms of dry eye, symptoms can come and go. Completing a thorough eye exam with a UAB Callahan Eye Hospital Ophthalmologist is the best way to prevent and protect your vision. <a href=\"https:\/\/www.uabmedicine.org\/appointment-callahan\" target=\"_new\">Click here<\/a> to schedule an appointment if you feel you have these symptoms, despite the results of this quiz. Or call <a href=\"tel:205-258-0034\">205.258.0034<\/a> to speak with our scheduling office.<\/strong><\/p><\/div><div id=\"field_128_17\" class=\"gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\" ><p><b>Difficulties from Dry Eye Symptoms<\/b><\/p><\/div><fieldset id=\"field_128_18\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Do you have difficulty reading?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_128_18'>\n\t\t\t<div class='gchoice gchoice_128_18_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='Yes'  id='choice_128_18_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_18_0' id='label_128_18_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_18_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='No'  id='choice_128_18_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_18_1' id='label_128_18_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_128_19\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Do you have difficulty using a computer?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_128_19'>\n\t\t\t<div class='gchoice gchoice_128_19_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='Yes'  id='choice_128_19_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_19_0' id='label_128_19_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_19_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='No'  id='choice_128_19_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_19_1' id='label_128_19_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_128_20\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Do you have difficulty driving?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_128_20'>\n\t\t\t<div class='gchoice gchoice_128_20_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='Yes'  id='choice_128_20_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_20_0' id='label_128_20_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_20_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_20' type='radio' value='No'  id='choice_128_20_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_20_1' id='label_128_20_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_128_21\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Do you have difficulty watching television?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_128_21'>\n\t\t\t<div class='gchoice gchoice_128_21_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='Yes'  id='choice_128_21_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_21_0' id='label_128_21_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_21_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_21' type='radio' value='No'  id='choice_128_21_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_21_1' id='label_128_21_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_128_22\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Do you experience blurred or fluctuating vision?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_128_22'>\n\t\t\t<div class='gchoice gchoice_128_22_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='Yes'  id='choice_128_22_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_22_0' id='label_128_22_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_22_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_22' type='radio' value='No'  id='choice_128_22_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_22_1' id='label_128_22_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_128_23\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Do you have difficulty being outdoors?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_128_23'>\n\t\t\t<div class='gchoice gchoice_128_23_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='Yes'  id='choice_128_23_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_23_0' id='label_128_23_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_23_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_23' type='radio' value='No'  id='choice_128_23_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_23_1' id='label_128_23_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_128_24\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Do your symptoms worsen throughout the day?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_128_24'>\n\t\t\t<div class='gchoice gchoice_128_24_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='Yes'  id='choice_128_24_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_24_0' id='label_128_24_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_24_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_24' type='radio' value='No'  id='choice_128_24_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_24_1' id='label_128_24_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_128_25\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Do you use drops and\/or ointment?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_128_25'>\n\t\t\t<div class='gchoice gchoice_128_25_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='Yes'  id='choice_128_25_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_25_0' id='label_128_25_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_25_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_25' type='radio' value='No'  id='choice_128_25_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_25_1' id='label_128_25_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_128_26' class='gform_previous_button button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_128\").val(\"3\");  jQuery(\"#gform_128\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_128\").val(\"3\");  jQuery(\"#gform_128\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_128_26' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_128\").val(\"5\");  jQuery(\"#gform_128\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_128\").val(\"5\");  jQuery(\"#gform_128\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_128_5' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_128_5' class='gform_fields top_label form_sublabel_below description_below'><fieldset id=\"field_128_27\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Do you wear contact lenses?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_128_27'>\n\t\t\t<div class='gchoice gchoice_128_27_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='Yes'  id='choice_128_27_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_27_0' id='label_128_27_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_27_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='No'  id='choice_128_27_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_27_1' id='label_128_27_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_128_28\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Do you have difficulty wearing contact lenses?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_128_28'>\n\t\t\t<div class='gchoice gchoice_128_28_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Yes'  id='choice_128_28_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_28_0' id='label_128_28_0'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_128_28_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='No'  id='choice_128_28_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_128_28_1' id='label_128_28_1'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_128_29\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_128_29' >How long can you comfortably wear contact lenses?<\/label><div class='ginput_container ginput_container_text'><input name='input_29' id='input_128_29' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_128_38\" class=\"gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\" ><h2 style=\"text-align: center;\">Your results show that you have no dry eye symptoms<\/h2>\n<p><strong>Even though your results show you have no symptoms of dry eye, symptoms can come and go. Completing a thorough eye exam with a UAB Callahan Eye Hospital Ophthalmologist is the best way to prevent and protect your vision. <a href=\"https:\/\/www.uabmedicine.org\/appointment-callahan\" target=\"_new\">Click here<\/a> to schedule an appointment if you feel you have these symptoms, despite the results of this quiz. Or call <a href=\"tel:205-258-0034\">205.258.0034<\/a> to speak with our scheduling office.<\/strong><\/p><\/div><\/div>\n                    <\/div>\n                    <div class='gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_128_31' class='gform_previous_button button' value='Previous'  onclick='jQuery(\"#gform_target_page_number_128\").val(\"4\");  jQuery(\"#gform_128\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_128\").val(\"4\");  jQuery(\"#gform_128\").trigger(\"submit\",[true]); } ' \/> <input type='button' id='gform_next_button_128_31' class='gform_next_button button' value='Next'  onclick='jQuery(\"#gform_target_page_number_128\").val(\"6\");  jQuery(\"#gform_128\").trigger(\"submit\",[true]); ' onkeypress='if( event.keyCode == 13 ){ jQuery(\"#gform_target_page_number_128\").val(\"6\");  jQuery(\"#gform_128\").trigger(\"submit\",[true]); } ' \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_128_6' class='gform_page' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_128_6' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_128_32\" class=\"gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\" ><h2 style=\"text-align: center;\">Your results show that you have no dry eye symptoms<\/h2>\n<h3><strong>Even though your results show you have no symptoms of dry eye, symptoms can come and go. Completing a thorough eye exam with a UAB Callahan Eye Hospital Ophthalmologist is the best way to prevent and protect your vision. <a href=\"https:\/\/www.jotform.com\/&quot;www.uabmedicine.org\/appointment-callahan\">Click here<\/a> to schedule an appointment if you feel you have these symptoms, despite the results of this quiz. Or call <a href=\"tel:205-258-0034\">205.258.0034<\/a> to speak with our scheduling office.<\/strong><\/h3><\/div><\/div><\/div>\n        <div class='gform_page_footer top_label'><input type='submit' id='gform_previous_button_128' class='gform_previous_button button' value='Previous'  onclick='if(window[\"gf_submitting_128\"]){return false;}  if( !jQuery(\"#gform_128\")[0].checkValidity || jQuery(\"#gform_128\")[0].checkValidity()){window[\"gf_submitting_128\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_128\"]){return false;} if( !jQuery(\"#gform_128\")[0].checkValidity || jQuery(\"#gform_128\")[0].checkValidity()){window[\"gf_submitting_128\"]=true;}  jQuery(\"#gform_128\").trigger(\"submit\",[true]); }' \/> <input type='submit' id='gform_submit_button_128' class='gform_button button' value='Get My Results'  onclick='if(window[\"gf_submitting_128\"]){return false;}  if( !jQuery(\"#gform_128\")[0].checkValidity || jQuery(\"#gform_128\")[0].checkValidity()){window[\"gf_submitting_128\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_128\"]){return false;} if( !jQuery(\"#gform_128\")[0].checkValidity || jQuery(\"#gform_128\")[0].checkValidity()){window[\"gf_submitting_128\"]=true;}  jQuery(\"#gform_128\").trigger(\"submit\",[true]); }' \/> <input type='hidden' name='gform_ajax' value='form_id=128&amp;title=&amp;description=&amp;tabindex=0' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_128' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='128' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_128' value='WyJbXSIsImQ4OGVkZmY0NjE4YzNjYTY4YTYyNWRhMjJjNDUzY2JkIl0=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_128' id='gform_target_page_number_128' value='2' \/>\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_128' id='gform_source_page_number_128' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/div><\/div>\n                        <\/form>\n                        <\/div>\n                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_128' id='gform_ajax_frame_128' title='This iframe contains the logic required to handle Ajax powered Gravity Forms.'><\/iframe>\n                <script>\ngform.initializeOnLoaded( function() {gformInitSpinner( 128, 'https:\/\/uabforms.hs.uab.edu\/blogs\/greyform\/wp-content\/plugins\/gravityforms\/images\/spinner.svg' );jQuery('#gform_ajax_frame_128').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_128');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_128').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_128').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_128').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_128').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/ jQuery(document).scrollTop(jQuery('#gform_wrapper_128').offset().top - mt); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_128').val();gformInitSpinner( 128, 'https:\/\/uabforms.hs.uab.edu\/blogs\/greyform\/wp-content\/plugins\/gravityforms\/images\/spinner.svg' );jQuery(document).trigger('gform_page_loaded', [128, current_page]);window['gf_submitting_128'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_128').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_128').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [128]);window['gf_submitting_128'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_128').text());}, 50);}else{jQuery('#gform_128').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gform_post_render', [128, current_page]);} );} );\n<\/script>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":5,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"\/web\/sites\/blogs\/greyform\/wp-content\/plugins\/uab-blank-page-templates\/templates\/uabmed-blank-template.php","meta":{"footnotes":""},"class_list":["post-425","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/uabforms.hs.uab.edu\/blogs\/greyform\/index.php\/wp-json\/wp\/v2\/pages\/425","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/uabforms.hs.uab.edu\/blogs\/greyform\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/uabforms.hs.uab.edu\/blogs\/greyform\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/uabforms.hs.uab.edu\/blogs\/greyform\/index.php\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/uabforms.hs.uab.edu\/blogs\/greyform\/index.php\/wp-json\/wp\/v2\/comments?post=425"}],"version-history":[{"count":1,"href":"https:\/\/uabforms.hs.uab.edu\/blogs\/greyform\/index.php\/wp-json\/wp\/v2\/pages\/425\/revisions"}],"predecessor-version":[{"id":426,"href":"https:\/\/uabforms.hs.uab.edu\/blogs\/greyform\/index.php\/wp-json\/wp\/v2\/pages\/425\/revisions\/426"}],"wp:attachment":[{"href":"https:\/\/uabforms.hs.uab.edu\/blogs\/greyform\/index.php\/wp-json\/wp\/v2\/media?parent=425"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}