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"The Convergence Insufficiency Symptom Survey (CISS) was designed to quantify the severity of symptoms associated with convergence insufficiency (CI)."* 

This survey has been used in multiple research studies and has been confirmed to be an effective in tool helping to identify those with visual symptoms and those who likely struggle with vision problems that can be treated!

Download and print the CISS to fill out on your own. A score of 16 or above could indicate an underlying visual dysfunction.