Complete the following questionnaire. If you have 3 or more "yes" responses you might benefit from further screening.

While you read do you ... ?
1. Skip lines or sentences	yes no
2. Insert words from lines above or below	yes no
3. Repeat or reread words and sentences	yes no
4. Lose your place	yes no
5. Get tired and or sleepy	yes no
6. Feel there is insufficient or too much light	yes no
7. Get headaches	yes no
8. Experience words disappearing	yes no
9. Experience words moving, changing or getting blurry	yes no
10. Shade your eyes	yes no
11. Have trouble understanding or remembering what you read	yes no
12. Omit small words	yes no

Do you have questions, wish to discuss the results of the questionnaire, or wish to inquire about further testing... Contact Sue or email me at SAR149@aol.com

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