SYMPTOM TEST VISION PROBLEMS SELF EVALUATION NEED HELP? SYMPTOMS EVALUATION Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.123Are you experiencing any of the following symptoms? Please indicate the symptoms you may have by selecting the checkboxes.Symptoms *Substitute words while reading or copyingReread words or linesReverse letters, numbers or wordsUse a finger or marker to keep place while reading/writingRead very slowlyHave poor reading comprehension (unless read to)Have difficulty remembering what has been readHold your head too close when reading/writing (within 7-8")Have unusual posture/head tilt when reading/writingHave headaches following intense reading/computer workHave eyes that hurt or feel tired after close workFeel unusually tired after completing a near visual taskHave double vision or see 2 imagesNotice vision blurs at distance when looking up from near workHave crooked or poorly spaced writingNotice that print seems to move or go in and out of focusHave poor spelling skillsNotice that letters or lines "run together" or words "jump" when readingMisalign letters or numbersMake errors when copyingHave difficulty tracking moving objectsNotice unusual clumsiness, poor concentrationHave difficulty with sports involving good hand-eye coordinationHave an eye that turns in or outSee more clearly with one eye than the otherFeel sleepy while readingDislike tasks requiring sustained concentrationAvoid near tasks such as readingBecome restless when working at a deskTend to lose awareness of surroundings when concentratingFind you must "feel" things to see themExperience carsicknessExperience unusual blinkingExperience unusual eye rubbingExperience dry eyesExperience watery eyesExperience red eyesHave eyes that are bothered by lightNextName *FirstLastEmail *Phone *Describe The SymptomsKindly elaborate on your symptoms to facilitate a comprehensive assessment, allowing us to offer tailored assistance towards the challenges you are facing.PreviousNextPreliminary AssessmentCriteria15 - 20 points total Possible functional vision problems 21 - 30 points total Probable functional vision problems Over 30 points total Definite functional vision problems YOUR SCORE *0 PreviousSubmit
