Questionnaire for individuals with low vision



The WBU Low Vision Committee is interested in increasing the involvement and inclusion of individuals with low or partial vision. One step toward that goal is learning more about how these individuals are involved in local organizations of and for the blind, what services are utilized, and the barriers or challenges in accessing services and being involved in the community.


By completing the survey below, you provide valuable information and insights into opportunities to increase the involvement of partially sighted individuals.


Please return your completed surveys to: penny.hartin@rogers.com by March 31st  . 



1. Country ________


2. Gender

__ Female

__ Male

__ Prefer not to answer


3. Age range

__ Under 18

__ 18 – 34

__ 35 – 60

__ Over 60


4. How long have you had low vision?

__ Since birth

__ Less than one year

__ Less than 5 years

__ More than 5 years


5. Employment status

__ Employed

__ Self-employed

__ Student

__ Unemployed

__ Retired


6. Are you affiliated or associated with an organization of or for the blind/partially sighted in your country or community?

__ Yes

__ No


7. If your answer to Question # 6 was "Yes", do you believe your wants and needs are being met or adequately represented by your organization?

__ Yes

__ No


8. If your answer to Question # 6 was “Yes”, how are you involved with the organization? Check all that apply:

__ I receive services

__ I am a member

__ I volunteer my time

__ I attend events or other social activities

__ I am a board member/other volunteer leadership role

__ I am an employee
__ Other (please explain): ________


9. How often are you involved in activities at the organization you are affiliated with?

__ Often

__ Sometimes

__ Never



10. If your answer to Question 6 was "No", and you are not affiliated with an organization of or for the blind/partially sighted, what do you think prevents you from affiliating with them?  (Answer all that apply)

__ There is no active organization close to where I live

__ I do not have transportation to attend their meetings or events

__ I thought that the organization was only open to those who are totally blind

__ I do not feel that the organization has programs or activities that meet my needs

__ I am not interested

__ Other (please explain): ________


11. Would you be more likely to participate if there was a specific organization for persons with low vision, or a subcommittee for persons with low vision?

__ Yes

__ No

__ Not sure


12. Do you have access to low vision rehabilitation services in your neighborhood? if yes, indicate the distance at which it is available

__ <10 km

__ >10 km

__ >50 km

__ >100 km

__ >300 km

__ There are no low vision services available


13. How do you identify yourself to the public as a person with low vision?

__ I use a white cane

__ I use a different coloured cane (what colour): ________

__ I use a guide dog

__ I use another form of identification (please describe): ________

__ I don’t use any identification


14. What are the most significant issues you face as a person with low vision? (Mark up to three choices)

__ Access to low vision assessment

__ Access to low vision rehabilitation services

__ Access to affordable low vision aids

__ Lack of public awareness about low vision

__ Lack of accommodation to meet my unique needs as a person with low vision

__ Feeling included in organizations of and for the blind and partially sighted

__ Accessible transportation

__ Access to information in formats that I can use

__ Access to groups or activities specifically oriented to people with low vision

__ Other (please explain): ________


Thank you for taking the time to complete this survey – the information you have provided will help determine opportunities to increase participation and inclusion of individuals with low vision. 

Please return your completed survey to penny.hartin@rogers.com by March 31st  


If you are interested in being involved with your local organization or would like to help advocate for inclusion of persons with low vision in your community, please complete the following:



City and Country:

Email address: