Print this page for each subject you test. Place a check mark in the box for the hand, foot, eye or ear that your subject uses in each test.
Part of Body | Test | Right Side | Left Side |
Hand | |||
Write name | |||
Use scissors | |||
Throw ball | |||
Drink from cup (optional) | |||
Fork to Mouth (optional) | |||
Foot | |||
Kick ball | |||
Step up stair | |||
Step on object | |||
Eye | |||
Look in tube | |||
Sight a finger | |||
Look through hole | |||
Ear | |||
Listen to whisper | |||
Listen to box | |||
Listen through wall |
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