1. RECORD FORM
Wechsler Adult Intelligence Scale- Revised
(WAIS-R)
Name:_______________________________________ Sex:_________ Age :_____________ Race: __________________
Marital Status:____________ Address:_______________________________________ Occupation:_________________
Education:____________________Place of Testing:_____________________ TestedBy: _________________________
 Clinicians who wish to drawto profile maydo soby locating thesubject’s rawscores on the tableaboveand drawing a lineto connect them. Seechapter 4
in the Manualfor a discussion ofthesignificance ofdifferences between scores onthetests.
Table of Scaled Score Equivalents
ScaledScore
RAW SCORE
Information
DigitSpan
Vocabulary
Arithmetic
Comprehension
Similarities
Picture
Completion
Picture
Arrangement
Block
Design
Object
Assembly
Digit
Symbol
ScaledScore
19 -- 28 70 -- 32 -- -- -- 51 -- 93 19
18 29 27 69 -- 31 28 -- -- -- 41 91-92 18
17 -- 26 68 19 -- -- 20 20 50 -- 89-90 17
16 28 25 66-67 -- 30 27 -- -- 49 40 84-88 16
15 27 24 65 18 29 26 -- 19 47-48 39 79-83 15
14 26 22-23 63-64 17 27-28 25 19 -- 44-46 38 75-78 14
13 25 20-21 60-62 16 26 24 -- 18 42-43 37 70-74 13
12 23-24 18-19 55-59 15 25 23 18 17 38-41 35-36 66-69 12
11 22 17 52-54 13-14 23-24 22 17 15-16 35-37 34 62-65 11
10 19-21 15-16 47-51 12 21-22 20-21 16 14 31-34 32-33 57-61 10
9 17-18 14 43-46 11 19-20 18-19 15 13 27-30 30-31 53-56 9
8 15-16 12-13 37-42 10 17-18 16-17 14 11-12 23-26 28-29 48-52 8
7 13-14 11 29-36 8-9 14-16 14-15 13 8-10 20-22 24-27 44-47 7
6 9-12 9-10 20-28 6 11-13 11-13 11-12 5-7 14-19 21-23 37-43 6
5 6-8 8 14-19 5 8-10 7-10 8-10 3-4 8-13 16-20 30-36 5
4 5 7 11-13 4 6-7 5-6 5-7 2 3-7 13-15 23-29 4
3 4 6 9-10 3 4-5 2-4 3-4 -- 2 9-12 16-22 3
2 3 3-5 6-8 2 2-3 1 2 1 1 6-8 8-15 2
1 0-2 0-2 0-5 1 0-1 0 0-1 0 0 0-5 0-7 1
Year Month Day
Date
Tested
Date of
Birth
Age
SUMMARY
VERBAL TEST
Raw Scaled
Score Score
Information _____ _____
Digit Span _____ _____
Vocabulary _____ _____
Arithmetic _____ _____
Comprehension _____ _____
Similarities _____ _____
Verbal Score _____
PERFORMANCE TEST
Raw Scaled
Score Score
Picture Completion _____ _____
Picture Arrangement _____ _____
Block Design _____ _____
Object Assembly _____ _____
Digit Symbol _____ _____
Performance Score _____
Sum ofScaled
VERBAL SCORE _______ FULL IQ_________
PERFORMANCE_______

2. 1. INFORMATION(Discontinue after 5
consecutivefailures)
Score
1 or 0
1. Flag
2. Ball
3. Months
4. Thermometer
5. Sun
6. Presidents
7. Weeks
8. Armstrong
9. Panama
10. Labor Day
11. Brazil
12. Hamlet
13. Civil War
14. Earhart
15. Clothes
16. Italy
17. King
18. Genesis
19. Sahara
20. Relativity
21. Yeast
22. Senators
23. Paris
24. BloodVessels
25. Temperature
26. Curie
27. Population
28. Koran
29. Faust
Max = 29
3. DIGIT SPAN (Discontinue after failure on BOTH TRIALS ofany item.
Administer BOTH TRIALS ofeach item. Even ifthe subject passestrial.)
DIGITS FORWARD Pass/
Fail
Score
2, 1, or 0
DIGITS BACKWARD Pass/
Fail
Score
2, 1, or 0
1. 5 – 8 – 2 1. 2 – 4
6 – 9 – 4 5 – 8
2. 6 – 4 – 3 – 9 2. 6 – 2 – 9
7 – 2 – 8 – 6 4 – 1 – 5
3. 4 – 2 – 7 – 3 – 1 3. 3 – 2 – 7 – 9
7 – 5 – 3 – 8 – 6 4 – 9 – 6 – 8
4. 6 – 1 – 9 – 4 – 7 – 3 4. 1 – 5 – 2 – 8 – 6
3 – 9 – 2 – 4 – 8 – 7 6 – 1 – 8 – 4 – 3
5. 5 – 9 – 1 – 7 – 4 – 2 – 8 5. 5 – 3 – 9 – 4 – 1 – 8
4 – 1 – 7 – 9 – 3 – 8 – 6 7 – 2 – 4 – 8 – 5 – 6
6. 5 – 8 – 1 – 9 – 2 – 6 – 4 – 7 6. 8 – 1 – 2 – 9 – 3 – 6 – 5
3 – 8 – 2 – 9 – 5 – 1 – 7 – 4 4 – 7 – 3 – 9 – 1 – 2 – 8
7. 2 – 7 – 5 – 8 – 6 – 2 – 5 – 8 – 4 7. 9 – 4 – 3 – 7 – 6 – 2 – 5 – 8
7 – 1 – 3 – 9 – 4 – 2 – 5 – 6 – 8 7 – 2 – 8 – 1 – 9 – 6 – 5 – 3
Total Forward
Max = 14
Total Backward
Max = 14
+ =
Forward Backward Total
2. PICTURE COMPLETION
(Discontinue after 5 consecutive failures.)
Score
1 or 0
1. Door
2. Tennis
3. Frog
4. PlatingCard
5. Car
6. Pitcher
7. Glasses
8. Pliers
9. Coat
10. Beach
11. Mirror
12. Crab
13. Violin
14. Sun
15. Watch
16. Leaf
17. Man
18. Horse
19. Female profile
20. Woodpile
Max = 20

3. 4. PICTURE ARRANGEMENT (Discontinue after 4 consecutive failures beginning with item 2)
Arrangement Order
Correct or
Acceptable
Order
Score
(circle)
Arrangement Order
Correct or
Acceptable
Order
Score
(circle)
1. House 60” 1 CAP 0, 1, 2 6. Escape 90” HUNT 0, 2
2 7. Hill 90” HELPS 0, 2
2. Flirt 60” JANET
JNAET or AJNET
0, 1, 2 8. Fish 90” ANGLER,
ARNGLE,or
AGNLER
0, 1, 2
3. Romeo 60” SHADE 0, 1, 2 9. Robber 120” LUNCH 0, 2
10. Taxi 120” SAMUEL, OR
AMUELS
SALMUE
0, 1, 2
4. Louie 60” ARGUES 0, 1, 2
Total
Max = 20
5. Enter 90” OPENS
OENSP
0, 1, 2
Note: Be sure to include scores for items 1 – 5 in Total
5. VOCABULARY (Discontinue after 5 consecutive failures.)
Score
2, 1, or 0
1. Bed
2. Ship
3. Penny
4. Winter
5. Breakfast
6. Repair
7. Fabric
8. Assemble
9. Enormous
10. Conceal
11. Sentence
12. Consume
13. Regulate
14. Terminate
15. Commence
16. Domestic
17. Tranquil
18. Ponder
19. Designate
20. Reluctant
21. Obstruct
22. Sanctuary
23. Compassion
24. Evasive
25. Remorse
26. Perimeter
27. Generate
28. Matchless
29. Fortitude
30. Tangible
31. Plagiarize
32. Ominous
33. Encumber
34. Audacious
35. Tirade
Total Max = 70
Note: Be sure to include scores for items 1 – 3 in Total

4. 6. BLOCK DESIGN (Discontinue after consecutive failures)
Design Time Pass/Fail
Score
(Circle the appropriate score for each design)
1.60” 1 2
2 0 1 2
2.60” 1 2
2 0 1
3. 60” 0 16 – 60 11 – 15 1 – 10
4 5 6
4.60” 0 16 – 60 11 – 15 1 – 10
4 5 6
5. 60” 0 21- 60 16 – 20 11 – 15 1 – 10
4 5 6 7
6.120” 0 36 – 120 26 – 35 21 – 25 1 – 20
4 5 6 7
7.120” 0 61 – 120 46 – 60 31 – 45 1 – 30
4 5 6 7
8. 120” 0 76 – 120 56 – 75 41 – 55 1 – 40
4 5 6 7
9.120” 0 76 – 120 56 – 75 41 – 55 1 – 40
4 5 6 7
Max = 51
TOTAL
7. ARITHMETIC ( Discontinue after 4 consecutive failures)
Problem Response
Score
1 or 0
Problem Response Time
Score
(Circle)
1. 15” 10. 60”
11 – 60 1 – 10
0 1 2
2. 15” 11. 60”
11 – 60 1 – 10
0 1 2
3. 15”
12. 60”
11 – 60 1 – 10
0 1 2
4. 15”
13. 60”
16 – 60 1 – 15
0 1 2
5. 30’
14. 120”
11 – 120 1 – 15
0 1 2
6. 30”
Total
MAX = 19
7. 30”
8. 30”
9. 30”
8. OBJECT ASSEMBLY (Give entire test to all subjects.)
Object Time
Score
(Circle appropriate score for each object.)
1.Manikin 120” 21 – 120 16 – 20 11 – 15 1 – 10
0 1 2 3 4 5 6 7 8
2. Profile 120” 36 – 120 26 – 35 21 – 25 1 – 20
0 1 2 3 4 5 6 7 8 9 10 11 12
3. Hand 180” 51 – 180 36 – 50 26 – 35 1 – 25
0 1 2 3 4 5 6 7 8 9 10
4. Elephant 180” 51 – 180 31 – 50 21 – 30 1 – 20
0 1 2 3 4 5 6 7 8 9 10 11
Max = 41
Total

5. 9. COMPREHENSION (Discontinue after 5 consecutive failures)
Score
2, 1, or 0
1. Clothes
2. Envelope
3. Foods
4. ChildLabor
5. Deaf
6. Borrow
7. Movies
8. License
9. Taxes
10. Forest
11. Prescription
12. Iron
13. Land
14. Brooks
15. Swallow
16. Press
Total
Max = 32
10. DIGIT
SYMBOL
1 2 3 4 5 6 7 8 9
Score =
− ┴ О X =
2 1 3 7 2 4 8 2 1 3 2 1 4 2 3 5 2 3 1 4 5 6 3 1 4
1 5 4 2 7 6 3 5 7 2 8 5 4 6 3 7 2 8 1 9 5 8 4 7 3
6 2 5 1 9 2 8 3 7 4 6 5 9 4 8 3 7 2 6 1 5 4 6 3 7
9 2 8 1 7 9 4 6 8 5 9 7 1 8 5 2 9 4 8 6 3 7 9 8 6

6. 11. SIMILARITIES (Discontinue after 4 consecutive failures)
Score
2, 1, or 0
1. Orange - Banana
2. Dog - Lion
3. Coat - Suit
4. Boat - Automobile
5. Eye- Ear
6. Button - Zipper
7. North - West
8. Egg - Seed
9. Table - Chair
10. Air - Water
11. Poem - Statue
12. Work - Play
13. Fly- Tree
14. Praise - Punishment
Total
Max = 28