Sympton Survey Once you submit the survey, you will be able to view your results and a list of doctors in your area. Indicate below how often the following symptoms are experienced by you or your child: Headaches with near work* Never Seldom Occasionally Frequently Always Words run together while reading* Never Seldom Occasionally Frequently Always Burning, itchy, or watery eyes* Never Seldom Occasionally Frequently Always Skipping/repeating lines while reading* Never Seldom Occasionally Frequently Always Tilting head or closing one eye when reading* Never Seldom Occasionally Frequently Always Difficulty copying from a chalkboard* Never Seldom Occasionally Frequently Always Avoiding near work or reading* Never Seldom Occasionally Frequently Always Omitting small words when reading* Never Seldom Occasionally Frequently Always Writing uphill or downhill* Never Seldom Occasionally Frequently Always Misaligning digits/columns of numbers* Never Seldom Occasionally Frequently Always Poor reading comprehension* Never Seldom Occasionally Frequently Always Holding books or near work very close to eyes* Never Seldom Occasionally Frequently Always Short attention span with near work* Never Seldom Occasionally Frequently Always Difficulty completing assignments on time* Never Seldom Occasionally Frequently Always Saying "I can't" before trying something* Never Seldom Occasionally Frequently Always Clumsiness and knocking things over* Never Seldom Occasionally Frequently Always Poor use of time* Never Seldom Occasionally Frequently Always Losing belongings or misplacing things* Never Seldom Occasionally Frequently Always Forgetting things* Never Seldom Occasionally Frequently Always Name* First Last Email* HiddenYour ScoreCAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
