Adult and Childrens Opticians
Cardiff Est. 1989

02920 228 144

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Traumatic Brain Injury Questionnaire

Traumatic brain injury comes in many forms and disability extremes and in order to assess a person’s visual performance in a limited amount of time it is important understand their current capabilities and expectations. For example, it would be beneficial to know in advance if there is there a significant physical, mental or communication aspect to the injury so that testing may be adapted appropriately. To this end, please fill in the following questions as fully as possible – and add anything else that you feel might be useful to the assessment or in understanding the patient.

What to bring to the assessment

  • Please bring any (and all) glasses that the patient has with you – even if they do not currently wear them.
  • Please bring any magnifiers that the patient uses regularly.
  • Please bring an example of text that the patient would usually read and a sample of their writing if they would usually write.
  • Bring a sample of what they read easily and anything they struggle with but would like to read.

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.


Prefer to download?

Download a Word document instead.