Vision Therapy Questionnaire

Questions

1. How often do you have a comprehensive eye exam?

2. Do you currently wear glasses or contact lenses?

3. Do you have difficulty focusing on near objects (e.g., reading)?

4. Do you have difficulty focusing on far objects (e.g., seeing the board)?

5. Do you experience frequent headaches?

6. Do you experience eye strain or fatigue?

7. Do you have blurred vision?

8. Do you have difficulty with depth perception?

9. Do you have trouble tracking moving objects (e.g., following a ball)?

10. Is there a family history of vision problems or learning disabilities?