Printable Vision Quality of Life with Time Survey (VisQuaL-T) PDF
Vision problems can sometimes make dizziness worse. Reading, screens, busy places, driving, or visually demanding tasks may cause symptoms like dizziness, headache, eye strain, blurry vision, trouble focusing, or sleepiness. The VisQuaL-T asks how long someone can do certain activities before symptoms start. Your score does not give a diagnosis, but it can help show which visual activities may be harder to tolerate and help guide a conversation with a healthcare provider.
Why use the VisQuaL-T?
The Vision Quality of Life with Time Survey (VisQuaL-T) helps clinicians understand how long a patient can tolerate common visual activities before symptoms begin. This can provide useful context beyond vision or vestibular testing alone. The VisQuaL-T may be helpful when evaluating patients with dizziness, visual motion sensitivity, eye strain, headache, blurry vision, trouble focusing, screen intolerance, or symptoms that worsen with visually demanding tasks. It can also be used to track patient-reported change over time.
Common Clinical Uses
Clinicians may use the VisQuaL-T to:
Assess tolerance for visually demanding activities
Identify tasks that trigger dizziness, headache, eye strain, or blurry vision
Support baseline documentation and care planning
Guide treatment goals related to visual activity tolerance
Measure patient-reported change over time
Document functional progress during treatment
Access the Printable VisQuaL-T
The printable VisQuaL-T helps quantify symptom-limited tolerance for common daily activities. This tool is not diagnostic, but it can help document functional impact, monitor change over time, and support clinical discussion around visually induced or activity-related symptoms.
Complete the form to download the redesigned VisQuaL-T PDF:
Looking for the online version?
Our design team has made improvements to the visual design of the standard questionnaire and we are providing this free of charge. This information is relevant for clinicians looking to improve their understanding of the impact that dizziness has had on your daily activities. View the online version of the Vision Quality of Life with Time (VisQuaL-T) Calculator.Â