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Vision Rehabilitation Lifestyle Checklist

Please assign a value between 0 and 4 for each symptom. 0 is Never or Non-existent, 1 is Occasionally (1-2 times per month), 2 is Often (1-2 times every two weeks), 3 is Frequently (3-5 times per week), 4 is Always Happens. Also check off if the symptom existed prior to your injury/accident.