Concussion QuizDo you think you have ever had a concussion?YesNoIf yes, how many?A concussion could also be called:A mild strokeA migraineA mild traumatic brain injuryA seizureYou need to hit your head to get a concussion?TrueFalseYou have to lose consciousness (get knocked out) to have a concussion?TrueFalseYou can expect the same outcome with a second concussion as you had with the first?TrueFalseWhich of the following are symptoms of a concussion (Check all that apply): Constipation Dizziness / balance problems Difficulty swallowing Feeling very tired / difficulty sleeping Fever Headaches Memory problems / slowed thinking / poor concentration Nausea (sick to your stomach) Personality and mood changes Sensitivity to bright light / bothered by loud noise Vision changes All of the AboveIf you don't have symptoms immediately, you probably didn't have a concussion.TrueFalseHow long do symptoms of a concussion last?A couple of daysA couple of weeksA couple of monthsThe symptoms are premanentIt depends, every concussion is differentWhich of the following could result in a concussion? (Check all that apply) Accidental bumps to the head Bicycle accidents Blast injuries (veterans and immigrants) Motor vehicle accidents / whiplash Physical abuse / assualt Slips and falls Sports injuries All of the aboveNow that you have completed most of this quiz, do you think you have ever had a concussion?YesNoIf you have concussion symptoms in the future, where do you think you should go for treatment?Primary care clinicWalk in / urgency / express careEmergency RoomOtherExplain Other:Did you seek medical care?YesNoWhere did you seek medical care?Primary care clinicWalk in / urgency / express careEmergency RoomWhy didn't you seek medical care? (Check all that apply) Because concussions aren't a big deal Symptoms didn't bother me / got better quickly Couldn't afford it / too expensive OtherExplain Other:With greater awareness of head injury as a result of completing this quiz, are you now likely to take more precautions to prevent concussions of yourself and your loved ones (e.g. wearing a helmet when bicycling, getting a quality helmet when competing in contact sports, etc.)? Yes No I already take precautions to prevent a concussionWhat is your gender?FemaleMaleWhat is your age?*10 - 1415 - 1920 - 3940 - 5960+If you'd like to be added to out mailing list or Newsletter, please include your email below:EmailThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.
