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Childhood Athlete Concussions
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* Indicates required question
For statistical reasons, what is your age?
*
10-14
14-19
20-24
25+
Have you had any experience with concussions?
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If so please explain.
Your answer
How serious are concussions to you?
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Extremely serious
They're important
Somewhat serious
They don't concern me
They don't matter at all
Do you think as you get older head injuries get less and less serious?
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Please explain.
Your answer
Please check off any symptoms you think are involved with concussions.
*
If you know of symptoms that are not listed please write them in the text box below
Headaches
Dizziness
Hallucinations
Fatigue
Possible death while sleeping in the same day as receiving the head injury
Nausea
Extreme hunger
Sensitivity to light and noise
Other:
Required
In your opinion what is the difference between mild, moderate, and severe concussions?
Your answer
What is your own definition of a concussion?
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Your answer
On a scale of one to ten how much have you heard of information regarding concussions?
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None at all
1
2
3
4
5
6
7
8
9
10
Everywhere I go I see facts and information about them
Do you know of any professional athletes who have received concussions? If so, who?
Your answer
Do you plan to learn more about concussions and inform others about them?
*
Please explain.
Your answer
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