This screening checklist is based upon the College of Optometrists in Vision Development (COVD) Quality of Life (QOL) Checklist. This information is requested because auditory and visual processing problems can be associated. This form can be filled electronically then saved and sent, or alternatively can be printed for manual completion.
For parent or guardian to complete. (Exception: If your child has already been assessed by a behavioural optometrist you do not need to complete this form.)