HELPS TBI Screening HELPS TBI screening Step 1 of 5 20% Have you ever hit your head or been hit in the head?(Required) Y N Note: Think about incidents that may have occurred at any age, even those that did not seem serious at the time. Examples are vehicle accidents, falls, and sports. Domestic abuse, child abuse, and service-related injuries are also common causes of head trauma. Were you ever seen in the Emergency department, hospital, or by a doctor because of an injury to your head?(Required) Y N Did you ever loose consciousness or experience a period of being dazed, confused, or disoriented because of an injury to your head?(Required) Y N Do you experience any of these problems in your daily life since you hit your head?(Required) Y N Note: Select Y if two or more symptoms are present now that were not present before the head injury. Headaches, Dizziness, Anxiety, Depression, Difficulty concentrating, Difficulty remembering, Difficulty reading, writing, calculating, Poor problem solving, Difficulty performing your job/school work, Change in relationships with others, Poor judgement (being fired from job, arrests, fights) Any significant sicknesses?(Required) Y N Acquired brain injury can occur as a result of severe illness that cause direct inflammation to the brain (meningitis, encephalitis, brain tumor, etc.) or from oxygen deprivation (heart attack, stroke, blood loss, etc). REQUEST A FREE NO OBLIGATION CONSULTATION TODAY First name * Last name * Email * Phone I am a current resident of Washington state *
