Get Concussion Intake Form - Blue Sky Neurology - R2 My-dms

Filling out the Concussion Intake Form is an important step in ensuring you receive the appropriate care and treatment after a concussion. This guide will provide you with clear instructions on completing the form accurately and efficiently.

Follow the steps to complete the form successfully.

1. Press the ‘Get Form’ button to access the Concussion Intake Form and open it in the online editor.
2. Begin by entering your background information, including your name and the date of filling out the form. This is important for accurate record-keeping.
3. In the Injury Information section, provide the date and time of your injury, along with the nature of the injury. Clearly describe how the injury occurred and select the cause from the given options.
4. Indicate whether there was a loss of consciousness by checking 'Yes' or 'No.' If there was a loss of consciousness, specify the duration.
5. Fill out the Amnesia section by answering whether you have memory loss before or after the event, and provide the duration if applicable.
6. Report any seizures that may have occurred, and provide details in the space provided. Document any initial signs or symptoms that followed the event.
7. In the Past History section, indicate if you have had previous concussions and the number of past incidents. Specify the date of the last concussion and recovery duration.
8. Provide information regarding any baseline cognitive testing previously performed and check any relevant conditions you have faced in the past.
9. Move on to the Symptom Scale. For each symptom listed, rate its duration over the past 24 hours by selecting the appropriate score.
10. Once all sections are completed, review your entries for correctness. You can then save changes, download, or print the form for your records.

Ensure you complete the Concussion Intake Form online for timely and effective assessment.