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Symptom Checklist

SYMPTOM CHECKLIST

Determine if you or your loved one is in need of Highline Vision Center’s help by scoring your symptoms on our checklist below.

Determine if you or your loved one is in need of help by scoring your symptoms on our checklist below. Answer the questions below by ranking your symptoms from 0 to 4.

The scoring is as follows:
0 — never occurs
1 — seldom occurs
2 — occasionally occurs
3 — frequently occurs
4 — always occurs

*Quality of Life checklist courtesy of College of Optometrists in Vision Development