Preschool Educators Questionnaire | Vision One Eyecare

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Preschool Educators Questionnaire

Preschool Educators Questionnaire

Home Preschool Educators Questionnaire

Select Your Appointment Location*

Carrum DownsLangwarrinMornington

Personal Details*

Student Date of birth

General Behaviour

Lacks concentrationImpulsiveReceptive/language problemsGives up easilySlow to complete taskShort attention spanUnable to play with peers

Visual Analysis

Easily distractedPoor concentrationUnable to copy circles, shapes or lettersTraces, touches figures

Visual Problems

ClumsyComplains of headachesSores eyes/rubbingComplains of double visionTilts head to viewBecomes fatigued with near workShort attention spanRed eyes/eye turns

Visual Spatial

Motor overflowDoes not cross midlineUnable to copy or draw letters/numbers?Rotates body or paper when drawing.Changes hands when writingUses alternative strategies for determining left and right.

Visual Motor

Pencil grip-normalThumb & 3 fingersThumb wrapUnable to cut with scissorsExcessive finger tensionUnable to write own namePosture - close working distanceSkews body to one sideRotates body

Body Organisation

Poor organizationForgets where things areCannot hop on one footCannot jump and land with feet togetherUnable to ride a bicycle and use pedalsUnable to climb with control.Unable to walk on narrow lineUnable to stand on one foot with arms folded

Has the child had any other referrals or diagnosis?YesNo

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Carrum Downs

Carrum Downs Shopping Centre
Shop 18, 100 Hall Road,
Carrum Downs VIC 3201

carrumdowns@voeyecare.com.au

03 9782 9411

Langwarrin

230 Cranbourne-Frankston Road,
Shop 27A,
Langwarrin VIC 3910

langwarrin@voeyecare.com.au

03 9776 7702

Mornington

Bentons Square Shop 25,
210 Dunns Road,
Mornington VIC 3931

mornington@voeyecare.com.au

03 5975 5720

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Carrum Downs

Carrum Downs Shopping Centre
Shop 18, 100 Hall Road,
Carrum Downs VIC 3201

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Langwarrin

230 Cranbourne-Frankston Road,
Shop 27A,
Langwarrin VIC 3910

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Mornington

Bentons Square Shop 25,
210 Dunns Road,
Mornington VIC 3931

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