You or your child could be at risk of a Binocular Vision Dysfunction.
Please answer these questions pertaining to you or your child accordingly.

Check the most appropriate answer.
N= Never, S= Sometimes, O= Often, A= Always

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Score the Test:

Step 1:
For every “N” give that question a 0
For every “S” give that question a 1
For every “O” give that question a 2
For every “A” give that question a 3

Step 2:
Add all of the “S” numbers together.
Add all of the “O” numbers together.
Add all of the “A” numbers together.

Step 3:
Then Add the Three total numbers together to achieve your final score.

Results:
If your score is 15-25 then your Quality of Life is somewhat affected by your visual system.

If your Score is 25 or greater then your Quality Of Life is significantly affected by your visual system and an evaluation is strongly recommended.

Example:
5 S’s x 1= 5
10 O’s x 2 = 20
15 A’s x 3 = 45