The following is a complete
set of the forms we utilize during the first hour of an Initial Evaluation appointment. This would be the
portion completed by a therapist just prior to seeing the doctor. They are also listed in the order in which we
use them. Please reference your Initial Evaluation transcript for the manner in which we present the tests to
**We reference the patient and parent in our explanations of the Testing
Forms, we also use these forms for our adult patients being tested.
*If noted with an asterisk
we obtained a variation of this test/form from Dr. Steve Ingersoll, OD at the Excel Institute in Michigan which
we have since modified to use in our program.
1. Questions & Observations
Start with this
form; we address the patient, telling the parent we will ask them for comments after we get the patient’s
response. These questions help us assess if there are any visual learning problems in addition to visual
While the patient is taking the Gardner’s Test of Reversals, we ask the parent these questions; when asked orally
it often triggers answers not on the written history form. While we are asking, we also are observing the patient
as they perform this test, marking the appropriate boxes on the Scoring Form.
As the tester observes, they are noting or marking the appropriate boxes for behaviors they are seeing during each
specific test. Tester notes total score, then looks at age under the Age column (age of patient) to see if the
score is within that age range, ranked from 1 (good) to 3 (below age level). If they did not score in Rank 1, find
the score and note the age level scored. Any score not ranked 1 is below their age level and gets scored
accordingly. Also note any compensations used such as auditory rehearsal, motor rehearsal, or developmental
After instructions are given (“please cross out any number or letter that looks backwards or wrong”) this test is
completed while the parent is asked questions on the History Summary. The tester is making observations and noting
them on the Scoring Form during the questioning of the parent.
This test is used to determine whether the child is seeing the “big picture” or only concentrating on
Test Reference Sheet
Score sheet used by tester while patient is taking these tests.
Saccadic test: This variation of the King Devick test is timed and the scores (number of seconds) for each test are
totaled with the number of seconds for both tests (the first ‘demo’ card is not scored but is only used for
Pursuit test: This
variation of the Groffman Trackingtest is scored with the number of correct answers given in one
8. Visualization Test
Scoring sheet for raw scores and notations.
9. Visualization Test
This variation of the Getman Visualization test shows the patient’s ability to interpret and visualize spatial
relationships and mentally manipulate objects in space. Can they do this by visualizing or do they resort
to auditory or motor rehearsal
10. Visual Memory Test
This variation of the Monroe Visual Memory test assesses the patient's
ability to recall and reproduce a series of geometric forms after a
11. Wold Sentence Copy
Test & Scoring
The patient is asked to copy the words above onto the
lines below. The number of letters copied in one minute is recorded. Just as important are the observations made
by tester (grip, distance to paper, reversals, etc.)
12. Color Fields
A functional color field test (as used in syntonics testing) is given at this point to determined if the patient’s
functional field is constricted. This includes a sample print and interpretation from our computer testing program.
Grade level appropriate visagraph reading is taken with comprehension questions following.
14. Reflex Testing
The Moro, ATNR, STNR, TLR, and Spinal Galant reflexes are tested and noted on the assessment sheet if they were
present or not present.