Adult and Childrens Opticians
Cardiff Est. 1989

02920 228 144

childopt@aol.com
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Over 16’s Education Questionnaire

A person is often unaware of their difficulties and may not realise if they are misreading or inadequately absorbing content of text. They may also make adaptive postures to compensate for a difficulty, such as close working distances, excessive head movements or avoidance tactics that may only exhibit under the intense and prolonged working conditions in the busy sensory environment of a classroom.

An educator’s input is invaluable to understanding the full impact of a visual difficulty as they are ideally placed to observe symptoms of which a student may be unaware. I would be extremely grateful if you could watch closely over the next few days and complete this pre-assessment questionnaire as fully as you are able and feel free to add any extra information on the back or on a separate sheet.

Please ensure that all questionnaires are completed at least 2 weeks in advance of the appointment date. Without them a full examination may not be possible in the allocated time.

If you have any queries concerning this questionnaire, or you need a print version, please contact us.

Questionnaire

Prefer to download?

Download a Word document instead.

Example: teacher / tutor / parent

Board and OHP Work