Vision Self Test

Vision Self Test

Print this page, circle the most appropriate answer and fax it in to us.

(N=Never, S=Sometimes, O=Often, A=Always)

  1. Do you get blurred vision?                                               N  S  O  A
  2. Do you get sleepy while driving?                                   N  S  O  A
  3. Do your eyes itch or burn?                                              N  S  O  A
  4. Are your glasses working the way they should?    N  S  O  A
  5. Do you get headaches while reading?                        N  S  O  A
  6. Do you work on a computer?                                        N  S  O  A
  7. Do you try to adjust your glasses?                              N  S  O  A
  8. Do bright lights bother you?                                          N  S  O  A
  9. Do lights in the office bother you?                               N  S  O  A
  10. Do you wear sunglasses?                                                  N  S  O  A
  11. Are your eyes worse on some days?                           N  S  O  A
  12. Do your eyes feel tired?                                                    N  S  O  A
  13. Do objects appear double?                                              N  S  O  A
  14. Do you take medications?                                               N  S  O  A
  15. Do you visit the optometrist yearly?                         N  S  O  A

If you answer O=Often or A=Always to questions #1-14 then it is time for you to start “Check Yearly, See Clearly.”

Call us for an eye appointment today.

Our Doctors Find Out What's Really Going on and Explain It Simply

Our Doctors Find Out What's Really Going on and Explain It Simply