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Visual Symptom Checklist -  
  1. Click to check each symptom or visual problem that applies to you or someone you care for.
  2. If one or more symptoms of visual problems are checked, an eye examination by one of our doctors should be performed soon.
  3. Print this Printer Friendly page to bring to our office, or this information is lost.
  4. Then Make an Appointment

Excessive blinking or squinting

Rubs eyes

Crossed eyes (turned in or out)

Tilts or turns head

Closes or covers one eye

Difficulty copying from chalkboard or desk

Eyes tire easily

Reverses letters or words when writing

Omits and/or repeats letters or words

Confuses similar words and letters

Short attention span while reading

Avoids reading and other close work

Holds head too close to book or paper

Unusual tension or irritability with sustained visual activity (computer work, reading a book, desk work)

Difficulty understanding and/or remembering what has been read

Double vision

Blurred vision

Nausea when reading or doing other close work

Frequent headaches when reading or doing other close work

Confuses right and left directions

Frequent stumbling or tripping

Poor eye-hand coordination, including poor handwriting

Patient Name: Date:

Signature: ______________________________________

 

 

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WYOMISSING - 50 Berkshire Court

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DOUGLASSVILLE - 1050 Ben Franklin Hwy

Hours & Directions

(610) 374-3134

Hours & Directions

(610) 385-4333

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