Austin Vision Therapy Symptom Checklist

Functional Vision Symptom Checklist

Any of the following symptoms may indicate a functional vision problem. Functional vision problems can negatively impact reading, learning, work productivity, and quality of life. Please read and mark the symptoms that occur. This is a critical step in determining the type and amount of functional vision problems that may exist.
Do you or your child (check all that apply):
15-20 points= Possible functional vision problem
21-30 points= Probable functional vision problem
30+ points = Definite functional vision problem
15+ Points = Functional Vision Evaluation Recommended

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