|
|
|
|
|
|
|
|
| |
| What is your classification |
| |
|
|
|
|
| |
| Do you have a history of depression? |
| |
|
|
|
|
| |
| Do you have a history of a mental disorder that can affect your memory? |
| |
|
|
|
|
| |
| Do you have or been diagnosed with a cognitive disease? |
| |
|
|
|
|
| |
| Have you ever had a TBI (Tramatic Brain Injury)? |
| |
|
|
|
|
| |
| Have you ever suffered a concussion? |
| |
|
|
|
|
| |
| Have you every had surgery on your head &/or brain? |
| |
|
|
|
|
Loading...
