• TENNESSEE VISION THERAPY

    Please return all forms at least 48 hours prior to your appointment by fax, email or regular mail.

  • Home Vision Therapy Progress Report

  • 1. Have you been able to complete the home exercises on a regular basis?
  • 2. Do you understand the home therapy exercises?
  • 3. Are the home therapy exercises explained so they are easy to follow?
  • 4. Is your therapist able to answer your general questions about vision therapy?

  • 7. How many hours per day on: Computer , Phone , Video game      , TV      

  •  8. How many hours per day spent: Outside ,  Inside 

  • 9. Are you using proper visual hygiene (proper posture, slanted surface, proper lighting,breaks after 20 mins) when reading and writing?
  • Date
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  • TENNESSEE VISION THERAPY COVD Lifestyle Checklist

  • Rows
  • Should be Empty: