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Symptom Quiz Form

Symptom Quiz

Please rank each of the following symptoms. 0= Never, 1= Seldom, 2= Occasionally, 3= Frequently, 4= Always
Headaches with near work
Words run together when reading
Burning, itchy, watery eyes
Skips/repeats lines when reading
Head tilt/closes an eye when reading
Difficulty copying from the board
Avoids near work/reading
Omits small words when reading
Writes up/downhill
Misaligns digits/column numbers
Reading comprehension difficulty
Hold reading materials too close
Trouble keeping attention on reading
Clumsy, knocks things over
Double Vision
Vision is worse at end of the day
Poor eye-hand coordination
Car or motion sickness
Sensitivity to light
A score of 20 or more indicates the need for a functional vision evaluation.
Your score suggests that you may have a binocular vision problem that is affecting your performance in work, school, athletics, and other areas of your life. We recommend that you schedule an appointment for a developmental eye exam.
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    Location

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    Pursuit Vision Center Location

    Address

    24D&E East Roseville Road
    Lancaster, PA 17601, US

    Contact Information (717) 983-8836

    [email protected]

    Hours of Operation

    Our Regular Schedule

    Monday  

    9:00 am - 5:30 pm

    Tuesday  

    9:00 am - 5:30 pm

    Wednesday  

    9:00 am - 5:30 pm

    Thursday  

    9:00 am - 5:30 pm

    Friday  

    Closed

    Saturday  

    Closed

    Sunday  

    Closed

    24E East Roseville Road
    Lancaster, PA 17601

    (717) 983-8836