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Concussion Symptom Severity Quiz

How do you feel?
Use the below scale of 0 -6 to score yourself on the following symptoms, based on how you feel now.

concussion severity scale

Name

Email

1. Headache

2. “Pressure in head”

3. Neck Pain

4. Nausea or vomiting

5. Dizziness

6. Blurred Vision

7. Balance Problems

8. Sensitivity to light

9. Feeling slowed down

10. Feeling like “in a fog”

11. “Don’t feel right”

12. Difficulty concentrating

13. Difficulty remembering

14. Fatigue or low energy

15. Confusion

16. Drowsiness

17. Trouble falling asleep

18. More emotional

19. Irritability

20. Sadness

21. Nervous or Anxious

22. Sensitivity to noise

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Would you like to email us this report for further diagnosis during your appointment?  If YES, enter your email below and click “Submit Quiz”.  If NO, skip the name and email section, and instead click “Submit Quiz” to see your instant results.

What is your name? (not required)

What is your email? (not required)

Click Submit Quiz to see your results!

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