Vision & Academics
Indicate how often your child experiences the symptoms below. Keep track of how many points you earn for each question. Each answer is worth a certain number of points. Add up all of your points at the end of the survey. If your child tallies 20 or more points, then he/she is at risk for visual skills affecting reading, writing and learning.
Headaches with near work
Words run together while reading
Burning, itching or watery eyes
Skipping or repeating lines when reading
Tilting head or closing one eye when reading
Difficulty copying from a chalkboard
Avoiding near work or reading
Omitting small words when reading
Writing uphill or downhill
Misaligning digits or columns of numbers
Poor reading comprehension
Holding books or near work very close to eyes
Short attention span with near work
Difficulty completing assignments on time
Saying "I can't" before trying something
Clumsiness and knocking things over
Poor use of time
Losing belongings or misplacing things
Forgetting things
What's your total number of points?
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