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The post concussion symptom scale

Welcome to the healthcare management group inc.! In order to serve you better, please take a moment to complete this form, if you require assistance, please call or email the office.

The post concussion symptom form

Patient Information (please complete all of the fields below)

Instructions

Report your current experience of symptoms. After reading each symptom, please select the number that best describes the way you have been feeling today. A rating of 0 means that you have not experiences this symptom today. A rating of 6 means that you have experiences severe problems with this symptom today.

Post Concussion Symptom Form

Symptom

None

Mild

Moderate

Severe

HCMG

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