CONCUSSION SCREENING

Concussion Screening

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Loss of Consciousness
Seizure or Convulsion
Amnesia
Headache
Pressure in Head
Neck Pain
Nausea or Vomiting
Dizziness
Blurred Vision
Balance Problems
Sensitivity to Light
Sensitivity to Noise
Feeling slowed down
Feeling like in a fog
Don't feel right
Difficulty Concentrating
Difficulty Remembering
Fatigue or Low Energy
Drowsiness
Confusion
More Emotional
Irritability
Sadness
Nervous or Anxious
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Pass
Fail
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