Symptom Questionnaire

The following checklists identify many of the observable clues and symptoms that are observed in a child or adults with a vision problem. Please read through this list and check items that you have noted to occur for yourself, or if this is for your child, complete the form with your child.

Download The Children’s School Questionnaire

Download The Adult Vision Questionnaire


Children’s School Questionnaire: Any score 25 or greater is significant.

For the Adult Questionnaire: Any score 25 and above is significant.

Consider a comprehensive vision examination. Schedule an appointment today with Scheiman Vision Therapy through our our web form.