206.624.0737

1511 3rd Avenue, Suite 411
Seattle, WA 98101

Vision Quiz

COVD Quality of Life Checklist

To take the vision quiz, check the column which best represents the occurrence of each symptom.

Category

Symptom

Never

Seldom

Occas.

Freq.

Always

A Blur when looking at near
A Headaches with near work
A Sees worse at end of the day
A Difficulty copying from the Chalkboard
A Avoids near work/reading
A Holds head too close to the page
B Has double vision
B Words run together while reading
B Eyes burn, itch, or seem watery
B Falls asleep while reading
B Closes one eye or tilts head while reading
OR Dizzy or nauseous with near work
OR Writes up or down hill
OR Poor/inconsistent in sports
OR Avoids sports/games
OR Poor hand-eye coordination/poor handwriting
OR Clumsy/knocks things over
OR Car/motion sickness
OM Skips or repeats lines when reading
OM Misaligns digits/columns of numbers
P Reading comprehension is poor
P Trouble keeping attention on reading
P Says “I can’t” before trying
P Does not use his/her time well
P Does not make change well with money
P Loses belongings/things
P Forgetful/poor memory
ALL Difficulty completing assignments on time
ALL Does not judge distance accurately

Your Final Score:

Score >20 — There is a high risk of having a vision problem that makes it difficult to read, to learn, to comprehend and even to pay attention. Further evaluation with a Comprehensive Vision Examination is recommended.

Schedule an Appointment

Call us today with questions or to schedule your appointment.


Our office is pleased to serve; Seattle, Bellevue, Kirkland, Redmond, Issaquah, Bainbridge Island, Vashon, Mercer Island, Shoreline, Lynnwood, Totem Lake, Sammamish, Bothel, Renton, Burien, Tukwilla, Sea Tac, Kent, and other surrounding communities in Washington. Call us at 206.624.0737 or email us at vision@drkathleenkinney.com