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The Concussion Quiz

Concussion

If you are experiencing any symptoms related to a concussion or head injury, seek medical attention immediately. This quiz is a tool to identify symptoms you may be experiencing and help find an Athletico clinic near you.

Are you 18 years or older?*
- Yes
- No
What is your first name?*
What is your last name?*
What is your email?*
- I am submitting this quiz for my partner, child, parent or friend
Their Name*
First Last
Guardian Name*
First Last
Guardian Email*
Did an object hit your head?
- Yes
- No
Did you fall and hit your head?
- Yes
- No
Did your head make contact with another person?
- Yes
- No
What part of the head did the impact occur?
- Back
- Front/Forehead
- Right Side
- Left Side
Are you sensitive to noise or light?
- Yes
- No
Are you having a hard time concentrating at work and/or school?
- Yes
- No
Are you having persistent headaches?
- Yes
- No
Do you feel like you're reading slower than usual?
- Yes
- No
Do you develop headaches or eye pain when reading?
- Yes
- No
Do you have difficulty looking at your computer or other screens?
- Yes
- No
Do you have complaints of dizziness?
- Yes
- No
Do you feel off-balanced or clumsy?
- Yes
- No
- By clicking this box you agree to receive email communication from Athletico Physical Therapy
Comments
This field is for validation purposes and should be left unchanged.

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Athletico Physical Therapy complies with applicable Federal civil rights laws and does not discriminate on the basis of race, age, religion, sex, national origin, socioeconomic status, sexual orientation, gender identity or expression, disability, veteran status, or source of payment. You will be treated with dignity, compassion, and respect as an individual.

Athletico Physical Therapy cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, edad, religión, sexo, origen nacional, condición socioeconómica, orientación sexual, identidad o expresión de género, discapacidad, condición de veterano o fuente de pago. Serás tratado con dignidad, compasión y respeto como individuo.

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We care about you and your financial well-being.
Learn more about our Student Loan Repayment Program.

We care about you and your financial well-being.
Learn more about our Student Loan Repayment Program.

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