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Functional Vision Symptom Checklist

Any of the following symptoms may indicate a functional vision problem. 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 as you will need this when scheduling. Or, you can email us for a free report by clicking on the box at the right. We will send you a more detailed report on your results from the test. 

Check all that apply:

Free Report Symptom Checklist

 


Score: 0

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

 

Call or email Minnesota Vision Therapy Center today for a FREE functional vision evaluation.

mvtc@minnesotavisiontherapy.com

952-844-0844

877-756-0844

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