Benton Facial Recognition Test-Record Form Name No. Date Age. Gender Education Handedness. Examiner. 4. the Short Form fs Items for Short Form (SF) Se Sor fom Ge Sere PageNo. __ Correct Responses (7) Errors (circle) fea Long Form (LF) Sore. ——eESO— er rer a e_ 12346 Scam ey Un see 2 oO 23456 27 54 3 ayia 13456 28 52 4 @_ 12456 25 50 5 oo 12345 24 49 6 Qa 13456 23 a7 2 45 7 2 o_o 134 21 4a 8 a ew 256 20 a 8 QO O_ 435 18 39 10 aa oO 134 8 a7 " a a 235 7 36 2 QE oO 145 8 34 13 HO o_ 246 8 32 pai Short Form Number Correct 14 30 (Pages 19) 3 28 Z Basset eye - ae Remaining Items for Long Form (LF) ~ 4 oO @_ 6 246 18 eo w— 156 2. Ad the Age/Education 16 Q_ 4) @_ 136 Correction to the Long 7 ()_ (4)__ ()__ 2a68 Sikora 18 @_ @_ @_ 125 Long Form Score 19 2 O_o 156 a 20 Qa) @_ @_ 456 Ss a O_O o_ 234 Corrected Long Form Score| 22 2 4 &_ 136 134 Komal Remaining tems Number Correct 38-40 Borderline ee 37-38 Moderate Impairment <87 Severe Impairment Long Form Total Number Correct (Pages 1-22) Observations: Psychological Assessment Resources, Inc. «16204 N. Florida Avenue «Lutz, FL 33549 «1.800.331.8878 « www parinc.com ‘Copyright © 1983 by Psychological Assessment Resources, nc. Al gh reserved, May nc be reproducadin whale crn part many form ory ary means without ‘ren permission of Peycholegical Assesemen Rescues, ne. This forms pated in gfeen ik on whitepaper. Any ther verin Is unaltherze 987654 Reorier#aOsee2 —ISENO-tasnSE22-4 Printed in he USA