Sight and Reading Ability Assessment Client Name: ______________________ Phone Number: _______________ Address/Room Number: __________________________________________ INSTRUCTIONS: First of all, you should try to find out the following before you begin. Could this person read prior to being diagnosed with dementia? Yes No What language(s) did he/she read? English French Other __________________________________________________ Does he/she need glasses: ( ) No ( ) Yes For distance For reading Are his/her glasses clean? If not, please clean them before you begin. Ask this person if he/she help you to determine the best size of print needed for people to see. Point to one sentence at a time, starting at the top of the page, with the largest size font. Use only the sheet with the six statements. Record your findings after you have completed the assessment. Size of Check if If he/she didn’t read Font he/she read full sentence, circle full sentence which words were seen. 72 point I am fine. I am fine. 48 point How are you? How are you? 36 point What a nice day. What a nice day. 24 point Tried and true. Tried and true. 16 point Live, and learn. Live, laugh and learn. 12 point Smile and the world Smile and the world smiles with you. smiles with you. ( ) Could not read the sentences. Form completed by: ________________________ Date: __________________
Sight and Reading Ability Assessment Client Name: ______________________ Phone Number: _______________ Address/Room Number: __________________________________________ INSTRUCTIONS: First of all, you should try to find out the following before you begin. Could this person read prior to being diagnosed with dementia? Yes No What language(s) did he/she read? English French Other __________________________________________________ Does he/she need glasses: ( ) No ( ) Yes For distance For reading Are his/her glasses clean? If not, please clean them before you begin. Ask this person if he/she help you to determine the best size of print needed for people to see. Point to one sentence at a time, starting at the top of the page, with the largest size font. Use only the sheet with the six statements. Record your findings after you have completed the assessment. Size of Font Check if he/she read full sentence If he/she didn’t read full sentence, circle which words were seen. 72 point I am fine. I am fine. 48 point How are you? How are you? 36 point What a nice day. What a nice day. 24 point Tried and true. Tried and true. 16 point Live, and learn. Live, laugh and learn. 12 point Smile and the world smiles with you. Smile and the world smiles with you. ( ) Could not read the sentences. Form completed by: ________________________ Date: __________________