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.
Please include things that they enjoy doing at the moment and do well as well as things they would like to do but are restricted for some reason. Are they physically independent in what they do or do they need significant support and what form does that take? Do they do any kind of job or learning and do they have any responsibilities (might be in the loosest sense)?
What do they hope to be able to do and what their carers expect or hope for from this assessment?