About Me
Services
Blog/Education
Resources and Links
Appointments
Contact Me
About Me
Services
Blog/Education
Resources and Links
Appointments
Contact Me
Concussion Screening 2024
Player Name
*
First Name
Last Name
Date of Birth
MM
DD
YYYY
Word Recall
Total out of 30
Concentration - Numbers
Total Out of 4
Balance - Single Leg
Opposite foot, errors in 20 secs
Balance - Tandem stance
Opposite foot at back, errors in 20 secs
Tandem Gait time
3m out and back, 3 trials
Delayed Recall
5 mins after initial, score out of 10
Performed by:
Thank you!