Headway Patient Symptoms Survey
We want to understand if the research currently being conducted towards brain and neck injuries are reflective of the needs of patients. Therefore, we need your help!

Please, let your voice be heard by sharing your experience with us to help us guide the future of research.
Sign in to Google to save your progress. Learn more
Email *
1. Name (Optional)
2. Age *
3. Gender *
4. City/State/Country *
5. How did you sustain your concussion? *
6. How long did it take you to recover? *
If you're still recovering, how long has it been since your last concussion?
7. What are/were your main symptoms? (Check all that apply) *
Required
8. How many concussions have you had? *
9. Where are/were your issues stemming from? (Check all that apply) *
Required
10. Which treatments helped aid in your recovery? (Check all that apply) *
Required
11. If medications/supplements helped aid in your recovery, which ones?
12. Which treatment centers and/or doctors do you feel made a major impact on your recovery? Which symptoms did they help with specifically?
13. Would you recommend this treatment center and/or doctor to another concussed person?
Clear selection
14. Are there any apps or programs that made a major impact on your recovery? Which symptoms did they help with specifically?
15. Do you feel there are any gaps in the current treatment and understanding of concussion or Post Concussion Syndrome (PCS)? If so, what?
16. Please rank the following rehabilitation areas you wish researchers were focusing on in connection with concussion:
1 - Most Important
2
3
4
5
6
7
8
9 - Least Important
Neck issues
Mental Health
Vestibular issues
Vision issues
Physical activity
Rest
Meditation
Nutrition
Other
Clear selection
17. If you'd like to elaborate on your answer above, please comment here.
18. Is there anything else you’d like us to know?
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of University of Minnesota Twin Cities. Report Abuse
Google Forms