Understanding the Brain Injury Recovery Community
The results of this onging survey, done in partnership with the San Diego Brain Injury Foundation, will be shared with the public. You will be able to view all responses after you complete this survey.

Your input will increase the understanding of the needs and experiences of the TBI community.

Thanks very much, in advance, for your help.

Dan Gardner, MD www.dangardnermd.com

Today's date *
MM
/
DD
/
YYYY
I am a ... *
Required
Gender *
Age *
Years after TBI injury *
Where do you live? *
What would you like to know about TBI? *
What is your biggest challenge / struggle dealing with TBI? (Please describe in detail.) *
How have you tried to meet your biggest challenge? *
YOUR CHANGES IN RESPONSE TO COVID-19
Are COVID-19 disruptions affecting you PHYSICALLY? *
Not affected at all
Severely affected
Please describe specifically how COVID-19 disruptions are affecting you PHYSICALLY?
Have you stopped, added, or changed doses of any medications?
Clear selection
Are COVID-19 disruptions affecting you EMOTIONALLY? *
Not affected at all
Severely affected
Please describe specifically how COVID-19 disruptions are affecting you EMOTIONALLY?
Are COVID-19 disruptions affecting you FINANCIALLY? *
Not affected at all
Severely affected
Please describe specifically how COVID-19 disruptions are affecting you FINANCIALLY?
Watching / reading / listening to news *
Much less time
Much more time
What news are you reading / watching / listening to? *
Exercise *
Much less time
Much more time
What exercise(s) are you doing? *
Weight change *
Loss of 10 pounds or more
Gain of 10 pounds or more
How have your eating habits changed? *
Sleep time *
Much less
Much more
Sleep quality *
Much less
Much more
Describe your dreams / nightmares *
Energy level *
Much less
Much more
Memory *
Much worse
Much better
Ability to focus *
Much worse
Much better
Computer time *
Much less
Much more
How are you spending your computer time? *
Phone time *
Much less
Much more
Talking with family *
Much less
Much more
Talking with friends *
Much less
Much more
Do you think social distancing is necessary? *
Not at all
Abolutely
How are you coping with social distancing? *
Love it
Hate it
How do you stay connected with others? *
Required
What solitary activities are you engaged in? *
Anxiety / worries / fears *
None
Extreme
What are your specific worries and fears? *
In what ways are you addressing your specific worries and fears? *
Attitude about the future *
Very discouraged
Very hopeful
How do you stay safe and healthy? *
Required
How has your life and / or thinking changed in a positive way during COVID-19? *
What life lessons has COVID-19 taught you? *
How will your job change post-Covid-19? *
What changes would you like to see in your community, state, and the US after COVID-19? *
Please add comments here *
The results of this survey may be shared with the public. You can view all response after you complete the survey. Thanks very much for your help. Your input will increase the understanding of the needs and experience of the TBI community. Dan Gardner, MD www.dangardnermd.com and San Diego Brain Injury Foundations www.sdbif.org
Dan Gardner, MD and San Diego Brain Injury Foundation
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy