ClearVue Eye Care / Our Services / Visual Skills Clinic

First tell us a little about yourself.

First Name

Last Name

Email Address

Phone Number

City

Now tell us a little about what you are experiencing.

Do you (or your child) experience headaches or fatigue after reading or using the computer?

All the time

Sometimes

Never or Rarely

Do you (or your child) have a short attention span?

YES

NO

Do you (or your child) experience difficulty remembering written content?

YES

NO

Do you (or your child) have poor eye-hand or general coordination?

YES

NO

Do you (or your child) frequently lose your place while reading or copying from a board?

YES

NO

Does a mismatch seem to exist between your actual performance and your potential at work or at school.

YES

NO

Are you (or your child) an athlete looking to enhance visual reaction time, peripheral awareness, dynamic visual acuity or visualization skills?

YES

NO

Do you (or your child) have a history of neurologic or developmental disorders, or has there been head trauma?

YES

NO

That's it! Just hit submit.

Vision Therapy Symptom Survey