Vision problems can affect many areas of your life. Please review the Symptom Checklist below and check all symptoms that you have observed. If you can check off many of these symptoms for your child or yourself, there is a good chance that there are vision problems that can be helped.

____ Blur when looking up close

____ Double vision

____ Headaches or rapid fatigue when working up close

____ Words run together when reading

____ Skips or repeats words or lines when reading

____ Dizziness/nausea when reading

____ Tilts head/closes one eye when reading

____ Difficulty copying from the board

____ Avoids near work/reading

____ Poor handwriting

____ Writes uphill or downhill

____ Misaligns digits or columns of numbers

____ Poor reading comprehension

____ Poor/inconsistent in sports

____ Avoids sports or games that require eye-hand coordination

____ Holds reading material too close

____ Homework takes “forever”

____ Does not judge distance accurately

____ Clumsy/knocks things over

____ Labeled “lazy”, “slow learner”, “ADD/ADHD”, or “behavior problem”

Feel free to print out this checklist and bring it into the office.