| Condition |
T |
B |
F |
VP |
| Skip lines while reading or copying |
X |
X |
|
|
| Lose your place while reading or copying |
X |
X |
|
|
| Skip words while reading or copying |
X |
X |
|
|
| Substitute words while reading or copying |
X |
X |
X |
|
| Reread words or lines |
X |
X |
|
|
| Headaches after intense visual activities such as reading or computer work |
X |
X |
X |
|
| Eyes hurt or feel tired after close work |
X |
X |
X |
|
| Vision blurs at distance when looking up from near work |
|
X |
X |
|
| Crooked or poorly spaced writing |
|
|
|
X |
| Unable to make a picture in your mind while reading |
|
|
|
X |
| Poor word recall & recognition |
|
|
|
X |
| Does not know math facts automatically |
|
|
|
X |
| Totals |
21 |
24 |
12 |
15 |
| Maximum Possible |
69 |
84 |
54 |
55 |
