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Self Test

You can fill in the form and submit the Self Test to the Clinic of your choice or you can download the Self Test  and complete and bring to your appointment.

Fields marked with * are required

Start of form

Go to: Are you light sensitive?

Are you light sensitive?

Go to: Types of reading difficulties:

Types of reading difficulties:

Go to: While reading or using a computer, do you:

While reading or using a computer, do you:

Go to: Do you feel strain, fatigue, get tired, or have headaches when:

Do you feel strain, fatigue, get tired, or have headaches when:

Go to: Handwriting:

Handwriting:

Go to: Attention/Concentration

Attention/Concentration:

Go to: Copying:

Copying:

Go to: Writing:

Writing:

Go to: Mathematics:

Mathematics:

Go to: Music:

Music:

Go to: Depth Perception:

Depth Perception:

Go to: Driving:

Driving:

Go to: Sports Performance:

Sports Performance:

Go to: Fatigue while In A Car:

Fatigue while In A Car:


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