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about us

Brain Test Form

Student Performance Questionnaire

This quick survey will allow a comparison of performance to underlying \skills and will help determine the reasons for high or low performance.

Person taking the test Who is completing this questionnaire?    Parent, guardian, or family member Teacher or other individual close to the subject


Read each of the following statements and rate the student by ticking YES’ or ‘NO’ for each item. Please be sure to rate every statement.

Compared to normal behavior for others of the same age and gender as the student, this student:

1. Has difficulty maintaining attention   Yes  No

2. Makes spelling errors in written work  Yes  No

3. Has a poor sense of direction/map reading skills  Yes  No

4. Is impulsive  Yes  No

5. Often asks to have things repeated  Yes  No

6. Has difficulty planning steps to solve problems  Yes  No

7. Completes assignments slowly  Yes  No

8. Avoids prolonged mental effort  Yes  No

9. Has difficulty sounding out unknown words  Yes  No

10. Misreads similar words  Yes  No

11. Has difficulty comprehending written materials  Yes  No

12. Distracted from the task at hand  Yes  No

13. Thoughts and materials are poorly organized  Yes  No

14. Generally does things slowly  Yes  No

15. Oral reading is slow or choppy  Yes  No

16. Has poor study or work habits  Yes  No

17. Has difficulty creating mental pictures  Yes  No

18. Has problems remembering  Yes  No

19. Poor or slow at math  Yes  No

20. Has difficulty doing two things at the same time  Yes  No

Locate Us

Lagos Address:
12 Tunde Fisayo Street
Off Admiralty Way
Lekki, Lagos State.

Port Harcourt Address:
3, Brentwood Close,
Inside School To Land Authority Complex,
ADP Road,
Port Harcourt, Rivers State.

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