{"id":2888,"date":"2024-08-05T12:31:17","date_gmt":"2024-08-05T10:31:17","guid":{"rendered":"https:\/\/systane-deq5.com\/?page_id=2888"},"modified":"2025-01-30T15:05:58","modified_gmt":"2025-01-30T13:05:58","slug":"deq2","status":"publish","type":"page","link":"https:\/\/systane-deq5.com\/uae-en\/deq2\/","title":{"rendered":"Questionnaire UAE"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"2888\" class=\"elementor elementor-2888\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-2e30c221 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"2e30c221\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-53bcbb16\" data-id=\"53bcbb16\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-731b75e2 elementor-widget elementor-widget-shortcode\" data-id=\"731b75e2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_3' style='display:none'><div id='gf_3' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">deq UAE<\/h2>\n                            <p class='gform_description'>deq<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_3'  action='\/uae-en\/wp-json\/wp\/v2\/pages\/2888#gf_3' data-formid='3' novalidate><div id='gf_page_steps_3' class='gf_page_steps'><div id='gf_step_3_1' class='gf_step gf_step_active gf_step_first'><span class='gf_step_number'>1<\/span><span class='gf_step_label'>Eye Lubricant<\/span><\/div><div id='gf_step_3_2' class='gf_step gf_step_next gf_step_pending'><span class='gf_step_number'>2<\/span><span class='gf_step_label'>Eye Discomfort<\/span><\/div><div id='gf_step_3_3' class='gf_step gf_step_pending'><span class='gf_step_number'>3<\/span><span class='gf_step_label'>Eye Dryness<\/span><\/div><div id='gf_step_3_4' class='gf_step gf_step_last gf_step_pending'><span class='gf_step_number'>4<\/span><span class='gf_step_label'>Watery Eyes<\/span><\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_3_1' class='gform_page tabs_heading' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_3_18\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_18'>Name<\/label><div class='ginput_container'><input name='input_18' id='input_3_18' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_3_18'>This field is for validation purposes and should be left unchanged.<\/div><\/div><fieldset id=\"field_3_1\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gquiz-field \"  data-field-class=\"gquiz-field\" ><legend class='gfield_label gform-field-label' >Question 1 A<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_3_1'>Are you using Dry Eye Lubricant currently?<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_1'>\n\t\t\t<div class='gchoice gchoice_3_1_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='NEVER'  id='choice_3_1_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_3_1\"   \/>\n\t\t\t\t\t<label for='choice_3_1_0' id='label_3_1_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_1_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='RARELY'  id='choice_3_1_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_1_1' id='label_3_1_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_3_16' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_3_2' class='gform_page' data-js='page-field-id-16' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_3_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_3_14\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gquiz-field \"  data-field-class=\"gquiz-field\" ><legend class='gfield_label gform-field-label' >Question 1 B<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_3_14'>During a typical day in the past month, how often did your eyes feel discomfort?<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_14'>\n\t\t\t<div class='gchoice gchoice_3_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='NEVER'  id='choice_3_14_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_3_14\"   \/>\n\t\t\t\t\t<label for='choice_3_14_0' id='label_3_14_0' class='gform-field-label gform-field-label--type-inline'>NEVER<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='RARELY'  id='choice_3_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_14_1' id='label_3_14_1' class='gform-field-label gform-field-label--type-inline'>RARELY<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_14_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='SOMETIMES'  id='choice_3_14_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_14_2' id='label_3_14_2' class='gform-field-label gform-field-label--type-inline'>SOMETIMES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_14_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='FREQUENTLY'  id='choice_3_14_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_14_3' id='label_3_14_3' class='gform-field-label gform-field-label--type-inline'>FREQUENTLY<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_14_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='CONSTANTLY'  id='choice_3_14_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_14_4' id='label_3_14_4' class='gform-field-label gform-field-label--type-inline'>CONSTANTLY<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_9\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gquiz-field \"  data-field-class=\"gquiz-field\" ><legend class='gfield_label gform-field-label' >Question 2 B<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_3_9'>When your eyes felt discomfort, how intense was this feeling of discomfort at the end of the day, within two hours of going to bed?<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_9'>\n\t\t\t<div class='gchoice gchoice_3_9_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='gquiz9f912c424'  id='choice_3_9_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_3_9\"   \/>\n\t\t\t\t\t<label for='choice_3_9_0' id='label_3_9_0' class='gform-field-label gform-field-label--type-inline'>NEVER<br> HAVE IT<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_9_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='gquiz9b39b706c'  id='choice_3_9_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_9_1' id='label_3_9_1' class='gform-field-label gform-field-label--type-inline'>NOT AT ALL INTENSE<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_9_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='gquiz9fd01cbd0'  id='choice_3_9_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_9_2' id='label_3_9_2' class='gform-field-label gform-field-label--type-inline'>TOLERABLE<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_9_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='gquiz9c90b3d4a'  id='choice_3_9_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_9_3' id='label_3_9_3' class='gform-field-label gform-field-label--type-inline'>MODERATELY INTENSE<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_9_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='gquiz9b814fd8b'  id='choice_3_9_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_9_4' id='label_3_9_4' class='gform-field-label gform-field-label--type-inline'>INTENSE<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_9_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='gquiz9faf3b818'  id='choice_3_9_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_9_5' id='label_3_9_5' class='gform-field-label gform-field-label--type-inline'>VERY <br>INTENSE<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_3_17' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_3_17' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_3_3' class='gform_page' data-js='page-field-id-17' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_3_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_3_7\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gquiz-field \"  data-field-class=\"gquiz-field\" ><legend class='gfield_label gform-field-label' >Question 1 C<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_3_7'>During a typical day in the past month, how often did your eyes feel dry?<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_7'>\n\t\t\t<div class='gchoice gchoice_3_7_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='gquiz171afa494'  id='choice_3_7_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_3_7\"   \/>\n\t\t\t\t\t<label for='choice_3_7_0' id='label_3_7_0' class='gform-field-label gform-field-label--type-inline'>NEVER<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_7_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='gquiz19884f99c'  id='choice_3_7_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_7_1' id='label_3_7_1' class='gform-field-label gform-field-label--type-inline'>RARELY<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_7_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='gquiz18c39f93e'  id='choice_3_7_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_7_2' id='label_3_7_2' class='gform-field-label gform-field-label--type-inline'>SOMETIMES<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_7_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='gquiz769be5665'  id='choice_3_7_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_7_3' id='label_3_7_3' class='gform-field-label gform-field-label--type-inline'>FREQUENTLY<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_7_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='gquiz79747f707'  id='choice_3_7_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_7_4' id='label_3_7_4' class='gform-field-label gform-field-label--type-inline'>CONSTANTLY<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_3_11\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gquiz-field \"  data-field-class=\"gquiz-field\" ><legend class='gfield_label gform-field-label' >Question 2 C<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_3_11'>When your eyes felt dry, how intense was this feeling of dryness at the end of the\nday, within two hours of going to bed?<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_11'>\n\t\t\t<div class='gchoice gchoice_3_11_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='gquiz9f912c424'  id='choice_3_11_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_3_11\"   \/>\n\t\t\t\t\t<label for='choice_3_11_0' id='label_3_11_0' class='gform-field-label gform-field-label--type-inline'>NEVER<br> HAVE IT<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_11_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='gquiz9b39b706c'  id='choice_3_11_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_11_1' id='label_3_11_1' class='gform-field-label gform-field-label--type-inline'>NOT AT ALL INTENSE<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_11_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='gquiz9fd01cbd0'  id='choice_3_11_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_11_2' id='label_3_11_2' class='gform-field-label gform-field-label--type-inline'>TOLERABLE<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_11_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='gquiz9c90b3d4a'  id='choice_3_11_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_11_3' id='label_3_11_3' class='gform-field-label gform-field-label--type-inline'>MODERATELY INTENSE<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_11_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='gquiz9b814fd8b'  id='choice_3_11_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_11_4' id='label_3_11_4' class='gform-field-label gform-field-label--type-inline'>INTENSE<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_11_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_11' type='radio' value='gquiz9faf3b818'  id='choice_3_11_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_11_5' id='label_3_11_5' class='gform-field-label gform-field-label--type-inline'>VERY <br>INTENSE<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_3_6' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='button' id='gform_next_button_3_6' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_3_4' class='gform_page' data-js='page-field-id-6' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_3_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_3_8\" class=\"gfield gfield--type-quiz gfield--type-choice gfield--input-type-radio gfield--width-full last gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gquiz-field \"  data-field-class=\"gquiz-field\" ><legend class='gfield_label gform-field-label' >Question 1 D<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_3_8'>During a typical day in the past month, how often did your eyes look or feel excessively watery?<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_3_8'>\n\t\t\t<div class='gchoice gchoice_3_8_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='gquiz171afa494'  id='choice_3_8_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_3_8\"   \/>\n\t\t\t\t\t<label for='choice_3_8_0' id='label_3_8_0' class='gform-field-label gform-field-label--type-inline'>NEVER<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_3_8_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='gquiz19884f99c'  id='choice_3_8_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_8_1' id='label_3_8_1' class='gform-field-label gform-field-label--type-inline'>RARELY<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice 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