Irlen Light Sensitivity Self Test

PERSONAL DETAILS
Name*
First Last
Email*
Phone
Are you?
1. Bothered by sunlight or glare?
- Yes
- No
2. Bothered by bright lights or fluorescent lights?
- Yes
- No
3. Bothered by headlights from oncoming traffic?
- Yes
- No
4. Bothered by glare off high gloss white paper?
- Yes
- No
5. Adjust the page when reading to eliminate glare?
- Yes
- No
6. Experience strain or fatigue working or reading under fluorescent lights?
- Yes
- No
7. Find your performance deteriorates under bright or fluorescent lighting?
- Yes
- No
8. Experience headaches when in fluorescent lighting?
- Yes
- No
9. Prefer to read in dim light?
- Yes
- No
10. Frequently wear sunglasses?
- Yes
- No
11. Feel like there is not enough light when reading?
- Yes
- No
12. Find computer screens / electronic device screens bright or glary?
- Yes
- No
13. Adjust the brightness of the screen on the computer / electronic devices?
- Yes
- No
14. Find cloudy days bright or glary?
- Yes
- No
Phone
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(make sure you print before you submit)

PERSONAL DETAILS