Brain Injury Vision Symptom Survey

If you or your child has suffered from a brain injury, this free online vision test helps determine if a Vision Rehabilitation Evaluation is needed. When answering for a child, ask the following questions exactly as written. If the child responds with “yes”, please ask “how often” and answer accordingly. Try not to give examples.

Symptom Survey


If your results suggest a Post-Brain Injury Vision Problem, please fill out the form below and one of our Patient Care Coordinators will be in touch to answer your questions or help schedule an evaluation for you.

Disclaimer: The questions in this survey were pulled from the Neuro-Optometric Rehabilitation Association’s Brain Injury Vision Symptom Survey (BIVSS). These questions are proven to be valid and reliable based on Laukkanen, Hannu, Scheiman, Mitchell and Hayes, John R. research. This survey only attempts to analyze the symptoms of  Post-Concussion Vision Problems and does not omit the need for a vision evaluation by a licensed optometrist. If you are struggling with a vision dysfunction, always consult your primary care optometrist or Neuro-Optometric optometrist.
Reference: Laukkanen, H., Scheiman, M., & Hayes, J. R. (2017). Brain Injury Vision Symptom Survey (BIVSS) Questionnaire. Optometry and Vision Science94(1), 43-50. doi:10.1097/opx.0000000000000940