Get the free Concussion Pre-Visit Questionnaire - Adult ages 13

Concussion Revisit Questionnaire Adult ages 13+ Name Date: DOB: Date of injury: / / Sport/Team/School: Age: Grade: Years of Education Completed: Dominant Hand: Right Left Both How did your injury

How to fill out concussion pre-visit questionnaire

How to fill out a concussion pre-visit questionnaire:

1. Start by reviewing the questionnaire carefully. It is important to understand the purpose of each question and provide accurate information.
2. Begin by filling out your personal information such as your name, age, and contact information. This helps the healthcare provider identify you and provide appropriate follow-up.
3. Answer all the questions honestly and to the best of your ability. Provide details wherever necessary, such as the dates and circumstances of any previous head injuries.
4. If you're unsure about any question or have any concerns, don't hesitate to ask for clarification from the healthcare provider or their staff.
5. Take your time and don't rush through the questionnaire. Take breaks if needed, but try to complete it in a timely manner to ensure a smooth workflow during your visit.

Who needs a concussion pre-visit questionnaire:

1. Athletes: Individuals involved in contact sports such as football, rugby, soccer, hockey, and basketball are often required to complete a concussion pre-visit questionnaire before participating in these activities. This helps coaches, trainers, and medical personnel assess the athletes' risk of concussions and provide appropriate care in case of injury.
2. Individuals with a history of head injuries: Anyone who has experienced previous head injuries, regardless of whether they are athletes or not, may be asked to complete a concussion pre-visit questionnaire. These individuals might include those who have been involved in accidents, falls, or other incidents that could potentially lead to concussions.
3. Military personnel: Due to the nature of their duties, military personnel may need to complete a concussion pre-visit questionnaire. This helps assess their likelihood of sustaining concussions during deployments or training exercises and ensures appropriate medical care is available.
4. Patients seeking rehabilitation or therapy: Individuals who are seeking rehabilitation or therapy for previous concussions or head injuries may be required to fill out a concussion pre-visit questionnaire. This helps healthcare providers gather necessary information to form a treatment plan and monitor progress.

Remember, the use of a concussion pre-visit questionnaire may vary among different healthcare providers or organizations. It is important to follow the instructions given by your specific healthcare provider and to provide accurate information for the best care possible.

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What is concussion pre-visit questionnaire?

Concussion pre-visit questionnaire is a form that collects information about a patient's history of concussions and symptoms that may help healthcare providers assess and manage concussions.

Who is required to file concussion pre-visit questionnaire?

Anyone who has a history of concussions or is at risk of sustaining a concussion is required to fill out the concussion pre-visit questionnaire.

How to fill out concussion pre-visit questionnaire?

To fill out the concussion pre-visit questionnaire, you need to provide accurate information about your history of concussions, symptoms, and any relevant medical history.

What is the purpose of concussion pre-visit questionnaire?

The purpose of the concussion pre-visit questionnaire is to help healthcare providers assess the severity of a concussion, develop a treatment plan, and monitor the patient's recovery.

What information must be reported on concussion pre-visit questionnaire?

The concussion pre-visit questionnaire collects information about previous concussions, symptoms experienced, medical history, and any current symptoms that may be related to a concussion.