We want to hear about your experiences with concussion recovery. Your responses will be completely anonymous unless you choose to leave your email address. Have questions? Contact us here. 

How would you identify yourself? *
What is the patient's gender? *
What is the age of the patient? *
Has the patient been diagnosed with previous concussions? *
How did the patient sustain his or her most recent concussion? *
Who provided follow up care after diagnosis? *
Which symptoms bothered the patient? *
Select all that apply.
What did the patient find frustrating about concussion recovery? *
Select all that apply.
Please describe the problem in your own words.
How long did it take the patient to recover?
Who was most helpful in providing information and guidance with recovery? *
Who do you expect to pay for all costs associated with concussion recovery? *