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The Concussion Quiz
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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 phone number?
*
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 Phone
*
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
State/Zip (This will help us guide you to the closest Athletico location that offers the treatment you need)
*
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Find an Athletico.
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