Rivermead post concussion symptoms questionnaire 2025

Get Form
concussion questionnaire Preview on Page 1

Here's how it works

01. Edit your concussion questionnaire online
Type text, add images, blackout confidential details, add comments, highlights and more.
02. Sign it in a few clicks
Draw your signature, type it, upload its image, or use your mobile device as a signature pad.
03. Share your form with others
Send concussion questionnaire pdf via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out rivermead post concussion symptoms questionnaire with our platform

Form edit decoration
9.5
Ease of Setup
DocHub User Ratings on G2
9.0
Ease of Use
DocHub User Ratings on G2
  1. Click ‘Get Form’ to open the rivermead post concussion symptoms questionnaire in the editor.
  2. Begin by entering your name, date of injury, and today's date at the top of the form. This personal information is essential for tracking your symptoms over time.
  3. Review each symptom listed in the questionnaire. For each symptom, compare your current experience to how you felt before the accident.
  4. Circle the number that best represents your current state for each symptom: 0 for not experienced at all, up to 4 for a severe problem now. Ensure you take your time to reflect on each symptom.
  5. If applicable, write any additional symptoms in the 'Other' section provided at the end of the list.
  6. Finally, sign and date the form at the bottom. If required, have your doctor sign as well to validate your responses.

Start using our platform today to easily fill out and manage your rivermead post concussion symptoms questionnaire for free!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.
Contact us
Questions are scored on a scale of 0 (not experienced at all) to 4 (a severe problem). An overall score between 16 and 35 may be indicative of post-concussion syndrome, and greater than 35 may also be predictive of moderate to severe limitations in brain function.
They may include: Headaches. Dizziness. Fatigue. Irritability. Anxiety. Depression. Trouble falling asleep or sleeping too much. Poor concentration and memory.
Each item is rated on a 5-point post concussion scale, from 0 = not experienced at all to 4 = a severe problem, then tallied. Symptoms are divided into: early symptoms (headache, dizziness, nausea and/or vomiting) and late symptoms, which can be scored and tracked separately in addition to the overall score.
The questionnaire requires rating of the presence of 16 symptoms (headaches, dizziness, nausea and/or vomiting, noise sensitivity, sleep disturbance, fatigue, irritability, depression, frustration, forgetfulness and poor memory, poor concentration, slow thinking, blurred vision, light sensitivity, double vision, and
Concussion clues may include: Dazed appearance. Listlessness and tiring easily. Irritability and crankiness. Loss of balance and unsteady walking. Excessive crying. Change in eating or sleeping patterns. Lack of interest in favorite toys. Vomiting.

People also ask

What Are the Symptoms of Post-concussion Syndrome? EmotionalCognitivePhysical Anxiety Brain fog Blood pressure changes Depression Difficulty concentrating Change in (or loss of) taste or smell Feeling overwhelmed Difficulty finding things Difficulty balancing Impulsiveness Difficulty reading Dizziness or vertigo17 more rows Oct 29, 2024
But sometimes symptoms may not occur for days after the injury, such as: Trouble with concentration and memory. Irritability and other personality changes. Sensitivity to light and noise.

rivermead concussion questionnaire pdf