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SAY: Think about what reading for information is like when you get to the point where you want to stop reading.
 
            You can answer "Often," "Sometimes," "Never," or Don't Know "D.K."

                                             READING DIFFICULTIES

  1. Do you accidentally skip lines or sentences?
      Often Sometimes Never D.K.

  2. Do you lose your place?  
      Often Sometimes Never D.K.

  3. Do you misread words? 
      Often Sometimes Never D.K.

  4. Do you unintentionally skip words?   
      Often Sometimes Never D.K.

  5. Do you read the same line over again?    
      Often Sometimes Never D.K.

  6. Do you misread words from lines above or below?   
      Often Sometimes Never D.K.

  7. Do you avoid reading or reading out loud?     
      Often Sometimes Never D.K.

  8. Is your reading slow or choppy? 
      Often Sometimes Never D.K.

  9. Are you bothered by white or glossy pages?   
      Often Sometimes Never D.K.

10. Do you look away, rest, or take breaks?       
      Often Sometimes Never D.K.

11. Are you restless, active, fidgety, or easily distracted?   
      Often Sometimes Never D.K.

12. Do you find that reading gets harder the longer you read?    
      Often Sometimes Never D.K.

13. Do you use your finger or marker?             
      Often Sometimes Never D.K.

14. Do you have a problem understanding what you read?    
      Often Sometimes Never D.K.

15. Do you have a problem remembering what you read?   
      Often Sometimes Never D.K.

16. Does it take effort to stay on the words you are reading?  
      Often Sometimes Never D.K.

17. What else happens when reading?              
      Often Sometimes Never D.K.
                              
 

                                              READING DISCOMFORT

  1. Do your eyes bother you?   
      Often Sometimes Never D.K.

  2.Do they get red or watery?   
      Often Sometimes Never D.K.

  3. Do they hurt, ache, or burn?  
      Often Sometimes Never D.K.

  4. Do they feel dry, sandy, scratchy, or itchy?    
      Often Sometimes Never D.K.

  5. Do you rub your eyes or around your eyes?  
      Often Sometimes Never D.K.

  6. Do you feel tired, drowsy, or fatigued?       
      Often Sometimes Never D.K.

  7. Does your head bother you?       
      Often Sometimes Never D.K.

  8. Do you get a headache?         
      Often Sometimes Never D.K.

  9. Do you get dizzy?    
      Often Sometimes Never D.K.

10. Do you feel nauseated or sick to your stomach? 
      Often Sometimes Never D.K.

11. Do you open your eyes wider?             
      Often Sometimes Never D.K.

12. Do you squint or frown?  
      Often Sometimes Never D.K.

13. Do you find yourself blinking frequently?        
      Often Sometimes Never D.K.

14. Do you move closer to or further from the page?  
      Often Sometimes Never D.K.

15. Does it bother you to read under fluorescent lights?     
      Often Sometimes Never D.K.

16. Is it harder to read in bright lighting?    
      Often Sometimes Never D.K.

17. What else bothers you?    
      Often Sometimes Never D.K.
                              

     Any comments you would like for us to be aware of?
           

Thank you