This free survey is powered by
Create a Survey
Surveys
2015
February
C
Concussions
Concussions
0%
Exit Survey
Hello:
You are invited to participate in our survey which involves concussions. In this survey, people will be asked to answer questions about receiving concussions and how they may have handled them. It will take approximately 10 minutes to complete the questionnaire.
Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.
Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact Tyler Thompson or by email at the email address specified below.
Thank you very much for your time and support. Please start with the survey now by clicking on the
Continue
button below.
What is your gender?
Male
Female
What is your age?
Younger than 18
18 - 24
25 - 34
35 - 44
45 - 54
55 - 64
65 or older
Prefer not to answer
In the most basic terms, describe what you believe to be a concussion.
Have you ever had a concussion?
Yes
No
Not Sure
If Yes, Was your concussion?
Physician Prescribed
Self Subscribed
If Self Prescribed, please explain how you handled the situation.
Check each box if you have experienced any of these symptoms.
Dizziness
Nausea
Memory Loss
Headaches
Fatigue
Delayed Responses
Were these symptoms followed by a blow to the head?
Yes
No
Were you aware that 90 % of concussions do not result in loss of conciousness?
Yes
No
Loading...
close
Loading...
Close
staticapp1.questionpro.net