Student Interview Please have your child fill out the following questions. The doctor would like to have a sample of your child’s writing if possible (not prompted or corrected by the parent)Name First Last Date MM slash DD slash YYYY 1. What do you like best at schoolWhy?2. What is hardest for you at school?Why?3. What do you not like at school?Why?4. What part of your school work do you wish you could do better?5. Do you like to read?Would you rather have someone read to you?6. What subjects do you have at school?7. What kind of stories do you like to read or listen to?8. Do you like to watch television?How many programs do you watch per day?9. What do you like to play?10. What do you like to do outdoors?11. What is your favorite sport?Do you play this sport?Would you like to be better in this sport?12. What are your hobbies?How much time do you spend at them?13. What can your friends do that you wish you could do better?14. Do you think you have good eyes and good vision?15. Do you think that your vision ever interferes with your school work?How?16. Do your eyes ever hurt?When?17. Does the print in a book ever look funny?When does this happen and what do you do about it?18. Can you always see what the teacher writes on the blackboard?What do you do if you cannot see it?19. Do things ever look blurred when you look up from reading?Does this happen often?What do you do about it?20. Does the print ever move, or double?Do you lose your place?21. Would you like to get better grades?22. Would you like to get help so that school work is easier?23. Is there anything else that you would like to say about your vision or your school work? Δ
