Vision Quiz

Signs of a Vision Problem

Please select the frequency. If the question does not apply select 'never'.

First Name*

Last Name

Email*

Phone Number*

Blur when looking up close*

Double vision*

Headaches working up close*

Falls asleep when reading*

Poor reading comprehension*

Skips/repeats words/lines when reading*

Loses place reading or copying*

Uses finger as a pointer*

Tilts head/closes one eye when reading*

Avoids near work/reading*

Print appears to move when reading*

Labeled “lazy”, “slow learner”, “AD(H)D” or “behavior problem”*

Dizziness/nausea with near work*

Misaligns digits or columns of numbers*

Excessive blinking/rubbing eyes*

Poor/inconsistent in sports*

Poor handwriting*

Difficulty copying from chalkboard*

Clumsy/knocks things over*

Car/motion sickness*

Sees worse at the end of the day*

Homework takes forever*

Appointment Recommended

If you find that you or your child have 3 or more symptoms in our quiz, it is recommended that you schedule an appointment for a full developmental vision evaluation.

The number of symptoms selected in your quiz is:​​​​​​​

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