To confirm: The injury was less than two weeks ago.
NEXT QUESTION: Does the patient have ANY of the following symptoms?
· Is the patient confused, lethargic, or disoriented?
· Does the patient have a severe headache?
· Has the patient vomited more than once?
· Is the patient deteriorating?
If the answer to ANY of those questions is YES, please do NOT use this form. These can be signs of a more serious brain injury, so please call 911 or go to an Emergency Room as soon as possible.
If the patient does NOT have any of the four symptoms listed, please click here to proceed to the next screen.