Visual Tracking Assessment Form
Please complete this Visual Tracking Assessment Form to help us evaluate visual tracking abilities. Answer each question carefully based on your observations or experience.
Participant Name
*
First Name
Last Name
How would you rate the participant's ability to follow a moving object smoothly with their eyes?
*
1
2
3
4
5
How often does the participant lose track of the moving object?
*
Never
Rarely
Sometimes
Often
Always
Does the participant show signs of eye fatigue during tracking tasks?
*
Not at all
Slightly
Moderately
Severely
How accurately does the participant anticipate changes in object direction?
*
1
2
3
4
5
Visual Tracking Behaviors
*
Rows
Never
Rarely
Sometimes
Often
Always
Loses place when reading lines of text
1
2
3
4
5
Needs to move head instead of eyes to track
6
7
8
9
10
Appears distracted during tracking tasks
11
12
13
14
15
Shows delayed response to moving objects
16
17
18
19
20
Does the participant require prompts or reminders to maintain focus on the tracking task?
Never
Occasionally
Frequently
Consistently
Please provide any additional comments or observations regarding the participant's visual tracking.
Submit
Should be Empty: