This vision test will help you determine if a vision condition is affecting you or your child's quality of life. Please mark the symptoms that occur and use the scoring criteria which will automatically calculate at the bottom of the page to determine if a functional vision evaluation is recommended. If you would like to schedule an evaluation, please make note of your score and let us know your results when setting up your appointment.

Criteria:

• 15-20 points total = Possible functional vision problems
• 21-30 points total = Probable functional vision problems
• Over 30 points total = Definite functional vision problems
• 15+ total points = Functional vision evaluation recommended

Symptom Checklist