Symptom Checklist

Use this symptom checklist to determine if you or your child may have a visual skills deficiency. Answer the questions below by ranking your symptoms from 0 to 4.

The scoring is as follows:
0 — never occurs
1 — seldom occurs
2 — occasionally occurs
3 — frequently occurs
4 — always occurs

Blur when looking at near

Double vision

Headaches with near work

Words run together or move when reading

Burning, itchy, watery eyes

Falls asleep reading

Sees worse at the end of the day

Skips/repeats lines when reading

Dizziness / nausea with near work

Head tilt / closing one eye when reading

Difficulty copying from board

Avoids near work / reading

Omits small words when reading

Misaligns digits / columns of numbers

Reading comprehension poor

Poor or inconsistent performance in sports

Holds books too close while reading

Trouble keeping attention while reading

Difficulty completing assignments on time

Always says, “I can’t,” before trying

Avoids sports / games

Poor hand-eye coordination (poor handwriting)

Does not judge distance accurately

Clumsy, knocks things over

Does not use his/her time well

Does not accept change well

Loses belongings and things

Car/motion sickness

Forgetful/poor memory

* Quality of Life checklist courtesy of College of Optometrists in Vision Development (COVD)

Your vision seems to be working well for you!

We want to see you annually for a routine eye health exam. Schedule your annual exam today by calling 303.325.2014.

We may be able to help you work and perform more comfortably.

Call 303.325.2014 today to schedule your complimentary performance based vision screening.

You are working far too hard at reading and near work and we can help!

Call 303.325.2014 today to schedule your complimentary performance based vision screening.

It’s urgent! You are suffering and your quality of life could be greatly enhanced.

You owe it to yourself to come in for our complimentary performance based vision screening. Call 303.325.2014 to schedule your screening today.