ChromaGen® Survey - Tampa Pilot - April 9, 2014

ChromaGen Survey - Tampa Pilot Study Questionnaire Page 1
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Important: It is imperative that the student answers these questions and not the parent. If you are a parent and helping your child fill out this survey online, make sure that they are the one answering each question.  There are a total of 20 questions to answer on this survey.

This survey is divided into two sections.  At the conclusion of this survey, we will score your results and inform you within 24 hours if you qualify for this pilot study. 
1. Do words or sentences become blurry or wiggly when reading? *This question is required.
2. Do words or sentences come in and out of focus when reading? *This question is required.
3. Do words ever move from side-to-side or up-and-down when reading? *This question is required.
4. Do words "float up" or "pop out" at you when reading? *This question is required.
5. Do the words ever "scrunch together" or "pop out" when reading? *This question is required.
6. Do you have double vision or see two words or sentences when reading? *This question is required.
7. Do the words move, jump, swim or appear to float on the page when reading? *This question is required.
8. Are the white spaces in between the lines more noticeable when reading or do the spaces move when reading? *This question is required.
9. Do you have problems with math where the numbers are not in straight columns or are moving? *This question is required.