Langwarrin: 03 9776 7702 Email Us

Mornington: 03 5975 5720 Email Us

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Teacher Questionnaire

Teacher Questionnaire

Home Teacher Questionnaire

Select Your Appointment Location*

Carrum DownsLangwarrinMornington

Personal Details*

Student Date of birth

Vision One Eyecare will handle all personal information in accordance with the Privacy Act.

Observable Behaviours possibly related to visual problems during home/school / outdoor environment.

Covers or closes eye when readingComplains of words moving on the pageComplains of headachesComplains of double visionComplains of eye strainInattentive / day dreamsPoor reading comprehensionLoses paces when reading

Signs of Focusing Problems

Complains of blurred vision when readingComplains of blurred vision looking from desk to boardBecomes fatigued when readingAvoids small printsComplains from copying from boardRubs their eyes when concentratingShort attention when readingHolds the book’s or any electrical devices close

Signs of Tracking Problems

Loses place oftenSkips wordsAnd lines oftenUses finger to keep placeShort attention span when reading

Signs of Visual Processing

Slow to learn letter / sound correspondenceSlow copying from board to book, takes many looksDoesn’t recognize the same word repeated on a pagePoor recall of visually presented materialTrouble with spelling and sight words vocabularySlow copying and completing worksheetsUntidy writingReverses letters numbersMistakes words with similar beginningsCan respond orally but not in writingErases excessivelyTrouble learning Maths and basic concepts of size.

Education History

Is school work?

AverageBetter than averageBelow averageHas your student’s school progress been as expected for ability?

Is your student having difficulty with:

ReadingWritingSpellingMaths

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Langwarrin

230 Cranbourne-Frankston Road,
Shop 27A,
Langwarrin VIC 3910

[email protected]

03 9776 7702

Opening Hours

Mon - Fri : 09:00 AM - 05:30 PM
Sat: 9.00 AM - 1.00 PM
Sun: Closed

Mornington

Bentons Square Shop 25,
210 Dunns Road,
Mornington VIC 3931

[email protected]

03 5975 5720

Opening Hours

Mon - Fri : 09:00 AM - 05:30 PM
Sat: 9.00 AM - 2.00 PM
Sun: Closed

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Choose From 3 Locations

Langwarrin

230 Cranbourne-Frankston Road,
Shop 27A,
Langwarrin VIC 3910

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Mornington

Bentons Square Shop 25,
210 Dunns Road,
Mornington VIC 3931

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Carrum Downs

Carrum Downs Shopping CentreShop 18,
100 Hall Road,
Carrum Downs VIC 3201

Carrum Downs Eyecare