FGHA Concussion Research Study
Thank you for contributing to our concussion research study to better understand the causes of concussions in youth hockey. You may skip a question or quit at any time if you do not feel comfortable answering. This data will be collected anonymously and contains no identifying information.
What organization does the player play for? Example: FGHA
Your answer
What is the player's year of birth?
Your answer
What is the player's approximate height and weight?
Your answer
What is the player's level and division?
Novice
Atom
PeeWee
Bantam
Midget
HL
B
BB
A
AA
Other
At what age did the player start playing hockey?
Your answer
Has the player suffered a hockey-related concussion?
If answer is no, please proceed to the end and hit submit.
How many concussions has the player suffered? Please list, including approximate dates.
Your answer
Please answer the following questions about the most recent hockey-related concussion the player has suffered.
What position was the player playing during the incident?
What zone did the incident happen in?
Which direction was the player skating?
What part of the head was impacted?
What kind of collision was it?
Where was the puck when the incident occurred?
Please provide any additional detail that you think is relevant... (eg. what caused the incident, was there a penalty called on the play, etc.)
Your answer
Submit
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