1. One eye turns, drifts or aims in a different direction than the other eye? Crossed eye? Wandering eye?
   (Look carefully -- this can be subtle. This is significant even if it only happens occasionally, such as when the person is tired, stressed or ill).
   
   
2. Frequent squinting or closing of one eye?
   
   
3. Excessive blinking or squinting?
   
   
4. Poor visual/motor skills (including "hand-eye coordination")?
   
   
5. Problems moving in space, frequently bumps into things or drops things?
   
   
6. Difficulties catching and/or throwing airborne objects?
   
   
7. Repeatedly confuses left and right directions?
   
   
8. Appears to favor the use of one eye?
   
   
9. Turns or tilts head in order to use one eye?
   
   
10. Posture problems? Head is frequently tilted to one side or one shoulder is obviously higher?
    
    

While reading or doing close work, do you notice any of the following in yourself or your child?

1. Becomes quickly fatigued?
   
   
2. Has posture problems?
   
   
3. Rubs eyes frequently?
   
   
4. Squints or blinks excessively?
   
   
5. Frequently loses one's place when reading or copying from the board or paper?
   
   
6. Frequently skips words and/or has to re-read?
   
   
7. Repeatedly omits small words?
   
   
8. Vision becomes blurry?
   
   
9. Uses finger to read?
   
   
10. Holds the book or object unusually close?
    
    
11. Closes one eye or covers eye with hand?
    
    
12. Twists or tilts head toward book or papers?
    
    
13. Moves head back and forth (instead of moving eyes)?
    
    
14. Struggles with handwriting?
    
    

Do you or your child frequently complain of:

1. Only able to read for short periods of time?
   
   
2. Burning or itching eyes?
   
   
3. Headaches in forehead or temples?
   
   
4. Nausea or dizziness?
   
   
5. Motion sickness?
   
   
6. Double vision?