• A vision symptoms questionnaire is required by the state to be submitted in the case of failed benchmarks, guardian or teacher concern, an initial SPED referral, and a SPED re-evaluation. 
  • Please be aware that the nurse has 30 days to reply.  
  • These forms must by filled out by guardians or teachers ONLY. 
  • This form will be reviewed weekly.  Vision Symptoms Questionnaire 
  • Please email vision@wasatch.edu with any questions or concerns.