Basketball Manitoba Concussion Survey
Please complete this anonymous survey on the subject of concussions and the sport of basketball.  No personal data will be asked and completion of the survey is optional.  The data collected will help Basketball Manitoba and our members learn more about concussions in our sport and develop ways to reduce them at all levels.

It is asked that the person who was diagnosed by a medical professional complete this survey after they have recovered from the incident and are back to normal.  
Sign in to Google to save your progress. Learn more
Gender *
What gender do you identify with?  
Age Range *
Please indicate your age range at the time of the concussion.
Basketball Activity *
When you received the concussion while playing basketball, it was during a...
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Basketball Manitoba.

Does this form look suspicious? Report