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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.