Adult Questionnaire

Adult Questionnaire for Vision Problems

To take the vision quiz, check the column which best represents the occurrence of each symptom.

Please know that email communication via our website may not be done through a secure platform. Although it is unlikely, there is a possibility that information you include in your submission can be intercepted and read by parties other than the intended recipient. To protect your confidential information, please do not include personal identifying information such as your birth date or personal medical information in any emails or website submissions you send to us.