Vision Checklist

These symptoms may indicate that you or your child may have have a vision problem. If you or any member of your family have any of these symptoms, a professional, comprehensive eye health vision exam can detect the problem.

Red, sore or itching eyes.
Jerky eye movements, one eye turning in or out.
Squinting, eye rubbing or excessive blinking.
Blurred or double vision.
Headaches, dizziness or nausea after reading.
Head tilting, closing or blocking one eye when reading.
Moving head back and forth rather than eyes, when reading.
Using a finger or marker to keep place while reading.
Lip reading or whisper reading to reinforce comprehension.
Poor eye-hand coordination.

Performance Clues

Avoidance of near work.
Frequent loss of place.
Omits, inserts or rereads letters/words.
Confuses similar looking words.
Failure to recognize the same word in the next sentence.
Poor reading comprehension.
Letter or word reversals after first grade.
Difficulty copying from the chalkboard.
Poor handwriting, misaligns numbers.
Book held too close to the eyes.
Inconsistent or poor sports performance.

Secondary Symptoms

Smart in everything but school
Low self-esteem, poor self image.
Temper flare-ups, aggressiveness.
Frequent crying.
Short attention span.
Fatigue, frustration, stress.
Irritability.
Day dreaming

Labeled


Lazy.
Dyslexic.
Attention deficit disorder.
Slow learner.
Behavioral problem.
Juvenile delinquent.
Working below potential.


Please complete the form below and click send. By doing so, your vision checklist will be e-mailed to us and will be used when we see you for your vision examination. Of course, all submitted information is kept strictly confidential.

Full Name (Last, First, MI)

Mailing Address

Phone Number

Date of Birth

E-Mail Address

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