Irlen Headaches, Migraines, Eye Strain, Fatigue Self Test

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PERSONAL DETAILS
Name*
First Last
Email*
Phone
Are you?
1. Bothered by sunlight?
- Yes
- No
2. Bothered by headlights from oncoming traffic?
- Yes
- No
3. Bothered by glare on overcast or hazy days?
- Yes
- No
4. Find fluorescent lights give you headaches?
- Yes
- No
5. Become tired or drowsy when in bright or fluorescent lights?
- Yes
- No
6. Frequently wear sunglasses?
- Yes
- No
7. Prefer to read in dim light?
- Yes
- No
8. Find bright, glossy paper bothers you or gives you a headache?
- Yes
- No
9. Find certain patterns annoy you i.e. music lines, carpet patterns?
- Yes
- No
10. Experience sore eyes or headaches when using computers?
- Yes
- No
11. Find your eyes hurt, burn, itch, water, feel dry or sleepy when reading?
- Yes
- No
12. Experience regular headaches or migraines?
- Yes
- No
13. Fatigue easily?
- Yes
- No

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PERSONAL DETAILS