Date..
SCORE SHEET-BENDER-GESTALT TEST
Name. .. .. Age . . . Sex .
Education. . . I.Q. . Diagnosis .
DESIGN 1 DESICN 4 DESICN 7
1. Wavy 1ine (2) 1. Asym. Crv. (3) 1. Ends no. join, (8)...
2. Dot, dash, cir. (3) 2. Break crv. (4) 2.
***** Angles ext. (3) *
3. Dashes (2) 3. Crv. not center. 3. Angles miss. (3)
(1).....
4. Circles (8) 4. Curls (4) 4. Ext, scat. (3)
5. No. dots (2) each ... 5. Not joined (8) 5. Dbl. line (1 ea.)
6. Dbl. row (8) * **** 6. Crv. rotation (3) 6. Tremor (4) ***** *
7. Workover (2) 7. Touch-up (8) 7. Distortion (8 ea.)
8. Sec. attempt (3 ea.) B. Tremor (4) 8. Cuide 1ines (2)
9. Rotation (8) 9. Distortion (8) **** 9. Sec. attempt (3 ca.).
10. Des. miss. (8) ... 10. Guide lines (2) 10. Rotation (8) ***
Design Total 1 1 . Sec. attempt (3 ea.) ...... 11. Des. miss. (8)
12. Rotation (8) Design Total
13. Des. miss. (8)
Design Total
DESIGN 2 DESICN 5 DESICN 8
1. Wavy line (2) 1. Asymmetry (3) 1. Ends no. join. ( 8 ) .
2. Dash or dots (3) 2. Dot, dash, cir. (3). 2. Angles ext. (3)
3. Shape cir. (3) 3. Dashes (2) * * 3. Angles miss. (3)
4. Cir. miss., ext. (3) 4. Circles (8) 4. Ext. scat. (3) ****
5. Cir. touch. (5) 5. Ext. join. dot (2) 5. Dbl. line (1 ea.)
6. Dev. slant (3) 6. Ext. rotation (3) 6. Tremor (4)
7. No. col. (2 ea.) 7. No. dots (2). , "7. Distortion (8 ea.) ***
:
8. Fig. on 2 lines (8) .. 8. Distortion (8) 8. Guide lines (2)
9. Guide lines (2) 9 . Cuide lines (2) .. 9. Workover (2)
10. Workover (2) 10. Workover (2) ..10. Sec, attempt (3 ea.)...
11. Sec. attempt (3 ea.)...... 11. Sec. attempt (3 ea.) .. 11. Rotation (8)
12. Rotation (8) 12. Rotation (8) **** 12. Des. miss. (8) ***
13. Des. miss. (8) . 1 3 . Des. miss. (8) Design Total
Design Total Design Total
DESICN 3 DESICN 6 CONFIC. DESICN
1. Asymmetry (3) 1. Asymmetry (3) 1. Place. Des. A. (2)
2. Dot, dash, cir. (3) 2. Angles (2) **** 2. Overlap (2 ea.)
3. Dashes (2) .. 3. P. crossing (2 ea.).. 3. Compression (3)
4. Circles (8) 4. Crv. extra (8) 4. Lines drawn (8)
5. No. dots (2) 5. Dbl. line (1 ea.) **** 5. Order (2)
6. Extra row (8) 6. Touch-up (8) . . 6 . No order (8)
7. Blunting (8) 7. Tremor (4) 7 . Rel. size (8)
8. Distortion (8) 8. Distortion (8) **** Total
9. Guide lines (2) 9. Guide lines (2) .. DESICN TOTALS
10. Workover (2) 10. Workaver (2)
11. Sec. attempt (3
ea.) ..... 11. Sec, altempt (3 ea.) . 2. 0.
12. Rotation (8) ..* 12. Rotation (8) .
13. Des. miss. (8)
13. Des. miss. (8) s . .
Design Total Design Total Conig
Total Raw Score Standard Score