Aurora Vision Training Survey August 21, 2024 vision training survey Name(Required) First Last Do you consent to us sending you one email with more information about vision training?(Required)YesNoWe promise we will not spam you!What is your email?(Required) What is your phone number? (optional)How would you prefer to be contacted?PhoneEmailHow old is your child?(Required) Our eyes lead the body. If there are difficulties with the visual system, it can cause many problems in many areas of life. Identifying these symptoms in conjunction with behavioral or cognitive traits can help us determine if a vision issue is present.How often do you notice the following symptoms?Gets headaches, dizzy or nauseated from near work like reading, drawing, or crafts(Required)NeverSeldomOccasionallyFrequentlyAlwaysNot SureHas burning, itchy, or watery eyes(Required)NeverSeldomOccasionallyFrequentlyAlwaysNot SureIs clumsy or uncoordinated, or knocks things over(Required)NeverSeldomOccasionallyFrequentlyAlwaysNot SureGets car or motion sickness(Required)NeverSeldomOccasionallyFrequentlyAlwaysNot SureEyesight becomes worse at the end of the day(Required)NeverSeldomOccasionallyFrequentlyAlwaysNot SureWhen eye teaming or eye function is not at its best, individuals tend to change their behaviour to accommodate their eyes.How often, if at all have you noticed these behaviours?Says "I can't" before trying something new or unfamiliar(Required)NeverSeldomOccasionallyFrequentlyAlwaysNot SureLoses belongings or things/ is forgetful or has a poor memory(Required)NeverSeldomOccasionallyFrequentlyAlwaysNot SureShort attention span with near work like reading, drawing, or crafts(Required)NeverSeldomOccasionallyFrequentlyAlwaysNot SureFalls asleep reading(Required)NeverSeldomOccasionallyFrequentlyAlwaysNot SureAvoids playing sports or games(Required)NeverSeldomOccasionallyFrequentlyAlwaysNot SureAvoids near work or reading(Required)NeverSeldomOccasionallyFrequentlyAlwaysNot SureOne of the biggest indicators of vision problems is when reading. When eyes are not functioning or teaming together reading becomes extremely difficult, often leading to stress or anxiety.When reading, how often do you notice these issues?Has double vision when reading(Required)NeverSeldomOccasionallyFrequentlyAlwaysNot SureSkips or repeat lines when reading(Required)NeverSeldomOccasionallyFrequentlyAlwaysNot SureTilts head or closes one eye when reading(Required)NeverSeldomOccasionallyFrequentlyAlwaysNot SureWords run together while reading(Required)NeverSeldomOccasionallyFrequentlyAlwaysNot SureOmits small words when reading(Required)NeverSeldomOccasionallyFrequentlyAlwaysNot SureExhibits poor reading comprehension(Required)NeverSeldomOccasionallyFrequentlyAlwaysNot SureHolds reading material too close to the face(Required)NeverSeldomOccasionallyFrequentlyAlwaysNot SureHas trouble maintaining attention on reading(Required)NeverSeldomOccasionallyFrequentlyAlwaysNot SureAcademic, sport, and social performance are all dependant on visual ability. Poor performance may not be an indicator of intelligence or aptitude, but instead, a byproduct of poor vision.How often do you notice these indicators?Writes uphill or downhill(Required)NeverSeldomOccasionallyFrequentlyAlwaysNot SureThis means that it is difficult to stay within the lines when writing on lined paper. Your sentence either veers upwards or downwards instead of staying relatively horizontal.Misaligns digits or columns of numbers(Required)NeverSeldomOccasionallyFrequentlyAlwaysNot SureHas difficulty completing assignments on timeThis question is required.(Required)NeverSeldomOccasionallyFrequentlyAlwaysNot SureFinds it difficult to copy from the board(Required)NeverSeldomOccasionallyFrequentlyAlwaysNot SureHas poor and inconsistent sports performance(Required)NeverSeldomOccasionallyFrequentlyAlwaysNot SureInaccurately judges distance(Required)NeverSeldomOccasionallyFrequentlyAlwaysNot SureShows poor hand-eye coordination(Required)NeverSeldomOccasionallyFrequentlyAlwaysNot SureCommentsThis field is for validation purposes and should be left unchanged.