Answer these questions for the individual for whom you are filling out this questionnaire.
Please explain any “yes” responses in the space provided below each question
Please explain any "yes" responses in the space provided below each question
Which of the following best describe your child (Choose all that apply)
Please describe in detail the type of problems the autistic individual for whom you are filling out this questionnaire is having which you feel could be helped by colored lenses.
The completed Autism Questionnaire and/or Colored Light Activity can be sent to the Irlen Institute, 5380 Village Road, Long Beach, CA 90808. For a fee of $28, a report will be sent indicating whether the child or adult with Autism is a candidate for Irlen Colored Filters.
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