Brain Injury Vision Symptom Survey

A validated 28-item self-assessment for vision symptoms associated with concussion and brain injury.

Predictive threshold: score ≥ 31 | Rate each symptom 0 (Never) – 4 (Always)

Your results have been sent to London Vision Training Clinic. A clinician will follow up with you.

Full Name *

Email Address

Phone Number

Symptom	0 Never	1 Rarely	2 Sometimes	3 Often	4 Always

Live Score

Progress

0 / 28 answered

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