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SPEED Questionnaire Name: ___, ___ (Last)Date: ___/___/___(First)DOB: ___/___/___Sex: Report the type of SYMPTOMS you experience and when they occur:SYMPTOM SAT THIS VISIT YESNOWITHIN PAST WITHIN
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The speed questionnaire - eyes is a form used to assess the visual ability of a person to perceive and react to speed.
Drivers, especially those in professions such as truck drivers or bus drivers, are usually required to file a speed questionnaire - eyes.
The speed questionnaire - eyes can be filled out by providing information about visual acuity, peripheral vision, color vision, and depth perception.
The purpose of speed questionnaire - eyes is to ensure that drivers have adequate vision to react to speed while operating a vehicle.
Information such as visual acuity measurements, results of vision tests, and any corrective lenses worn must be reported on the speed questionnaire - eyes.
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