Vision Development Center

of Lancaster

Symptoms Survey


Looking for Alternative Treatments for ADHD & ADD?

Take our Symptoms Survey.

If you observe any of these symptoms at school, work, or home it could indicate a vision related learning problem that requires treatment. These problems cannot be resolved without professional help.

Vision Therapy is the treatment of choice to reduce or eliminate those problems, increase overall performance, and improve learning and concentration skills that are most times linked to ADD or ADHD and other learning disabilities.

Please note: we ask that you fill in all the answers with the best answer possible and please include your name, a phone number to reach you at and/or a valid email address.

These surveys are then sent to our confidential and secure email. A staff member from our office will be reaching out to you to go over your survey and answer any other personal questions you may have, to determine if an appointment should be made.

Our office will not reveal any of your personal information to anyone, or sell your information. Again, we ask that you fill in all areas with the correct information.

 

  1. Do you have headaches? *
  2. Fatigue with reading or comprehension drops with time? *
  3. Confuse similar words or letters? *
  4. Short attention span? *
  5. Difficulty keeping place while reading; use finger as marker? *
  6. Slow reading or word-by-word reading? *
  7. Skip or reread lines; omit words? *
  8. Avoid reading or close work? *
  9. Reverses words or letters? *
  10. Difficulty remembering what has been read? *
  11. Tilts head to one side or closes/covers one eye? *
  12. Hold head too close to reading material? *
  13. Difficulty copying from chalkboard or book? *
  14. Poor eye-hand coordination, including poor writing? *
  15. Crossed eyes, turning in or out? *
  16. Nervousness, irritability, or restlessness after sustaining visual concentration? *
  17. Does your vision get blurry at any time? *
  18. Do you ever see objects doubled? *
  19. Do letters and lines “run together” or words “jump”? *
  20. Do your eyes feel strained or tired after working on a computer? *













  21. We respect your privacy. Your email is only used by Vision Development Center of Lancaster. Your information will never be used for any other purpose or used by 3rd parties.



    Your phone number is only used by Vision Development Center of Lancaster for the purposes of giving you the test results. Your information will never be used for any other purpose.