Symptoms Survey

Completing for:

Blurry vision while reading? (required)

Double vision while reading? (required)

Letters appear to move or swim on the page? (required)

Headache after extended reading (book or screen)? (required)

Eyestrain and fatigue after extended reading or school? (required)

Rubs eyes or blinks a lot while reading? (required)

Dizziness/nausea/stomach ache during reading or schoolwork? (required)

Schoolwork takes excessive time to complete? (required)

Avoidance of near vision tasks like reading and schoolwork? (required)

Short attention span with reading and schoolwork? (required)

Holds books/screen very close? (required)

Slow reading speed? (required)

Unable to read smoothly and accurately? (required)

Must re-read for comprehension? (required)

Difficulty remembering known words? (required)

Struggles with spelling? (required)

Understands stories better when being read to versus reading on their own? (required)

Difficulty copying notes in class? (required)

Skips/repeats lines and words? (required)

Loses place while reading? (required)

Suffers from car or motion sickness? (required)

Clumsy, accident prone, constantly knocks things over? (required)

If you would like to discuss the results, how would you like to connect:

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