Do I Have a Concussion?
I am more tired than usual
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I get headaches I never used to get
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I feel dizzy or light headed
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Busy visual environments hurt my eyes
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I struggle to remember things
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I am more irritable than usual
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Its difficult to get restful sleep
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
My neck is sore a lot
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I feel off balance
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
My eyes hurt when I use them too much
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
My brain crashes mid way through the day
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Its hard to manage my emotions
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I am nauseous a lot
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I get dizzy when I move my head around
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I get motion sick in the car
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Too much screen time bothers me
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I feel like I can't think as fast
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I feel a new sense of anxiety and/or depression
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I get stomach discomfort after eating
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
My neck never seems to relax, especially right underneath my skull
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I feel more uncoordinated than I used to
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Depth perception is more challenging than it used to be
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
I lose my train of thought often
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
When I'm tired, I get moody
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
When I stand up I get light headed
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Nothing helps my headache go away
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
My ears ring
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Bright lights make my eyes hurt
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
My brain feels slow
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
Little things bother me more
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
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