Functional Vision Checklist

Our Developmental/Functional Vision Checklist

It is always important to ask the right questions. Understanding a person’s visual history is the first step to providing the help they need. This checklist helps people begin to see how the visual process is involved in the problems they are having. People are often unaware of the role that the visual process plays in how they perform certain tasks. When these connections can be made, it is easier for people to understand the benefits of behavioral optometry. The conditions on this checklist are usually amenable to treatment with therapeutic lenses and/or vision therapy.

Feel free to fill out and Print the checklist below

Yes No
Frequent headaches
Eyes frequently red
Double vision
Closing or covering one eye
Eyes tire easily or hurt
Holding reading close
Tilting head while reading
Losing place while reading
Pointing to keep place on page
Words moving on page
Poor reading comprehension
Focus changes while reading
Getting drowsy while reading
Purposely avoiding reading
Difficulty completing work on time
Reversing letters/numbers
Difficulty with spelling
Poor handwriting skills
Short attention span
Blurry vision- far away
Blurry vision-close up
Focusing is slow from near to far (or far to near)
Discomfort during or after computer work
Poor general coordination
Motion sickness
Sensitivity to light
Color vision problems
Wearing an eye patch
Visual therapy

Contact Dr. Gallop for more information about behavioral optometry, vision therapy or how you did on this checklist.

To find a behavioral optometrist near you go to


Find us on the map


Our Regular Schedule


By Appointment


By Appointment


By Appointment


By Appointment


By Appointment