Print these Questions to ask dr so you can take them with you.
This TBI Questionnaire* has been designed to provide a standardized, efficient, and comprehensive way for TBI survivors to document their symptoms when they are at home, and they can take as much time as they need. It aims to enhance communication between patients and healthcare providers, reduce stress for patients, and ensure consistency in care.
Letter to TBI Survivor (English)
Carta a un Sobreviviente de TBI (Espanol)
Letter to TBI Survivor’s Healthcare Provider (goes with a copy of your completed TBI Q)
PLEASE NOTE: If links aren’t working properly….This page is still under construction…
TBI Questionnaire is a structured, self-report tool that helps survivors document their symptoms, ensuring they have a clear, standardized way to communicate their experiences with healthcare providers. These references reinforce the credibility of this approach and show that it is grounded in established screening methods. (References below)
Why the TBI Questionnaire Exists
After multiple TBIs over five decades, and witnessing countless survivors struggle to be heard, I knew something had to change. Too often, doctors rush through appointments, dismiss symptoms, or unknowingly trigger trauma by forcing survivors to verbally recount their injury—especially in cases of military-related TBIs and PTSD, and violent assaults.
The TBI Questionnaire (TBIQ) was created as a silent interlude, a way for patients to document symptoms at home and hand the completed form to their doctor—eliminating the stress of verbal explanations while ensuring nothing critical is overlooked, saving a lot of precious time.
This tool is designed to: ✅ Improve efficiency—Doctors can quickly review symptoms in an organized format. ✅ Reduce emotional burden—Patients can provide full details without verbal triggers. ✅ Ensure comprehensive care—Medical providers get a clear picture of long-term effects and daily struggles.
For many survivors—especially those in the military community—this simple step can make appointments more productive, respectful, and trauma-sensitive. No more feeling ignored, rushed, or unheard—just real, structured support for recovery.
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These sample Questionnaires will only give you an idea of the type(s) of Questionnaire(s) your healthcare provider has or might have.
There are a few short 1-page versions, as well as a 7-page version for people who have been suffering for 3 months or longer (which is included FYI, but meant for Providers).
There are also TBI Guides, information from the Department of Defense, and a 211-page document on the Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans.
1 STANFORD concussion-questionnaire-simple 1 page.pdf (Stanford Healthcare)
2.The Rivermead Post Concussion Symptoms Questionnaire* (1 page)
3. Acute Concussion Evaluation (Heads Up Clinicians) – 1 page Questionnaire (w/ 1 pg of instructions, etc.
4. Traumatic Brain Injury: A Guide for Patients (13 pages) (This guide was provided by the CogSMART program of the VA San Diego Healthcare System. The material presented is based on published scientific research and clinical studies and was adapted from a variety of sources)
5. SINCE THIS IS FOR PROVIDERS, IT IS INCLUDED “FOR YOUR INFORMATION ONLY“ – Microsoft Word – Materials for referring providers – concussions past 3 months.docx (Stanford Healthcare [Concussion & Brain Performance] – 7 pages)
DEPT OF DEFENSE: VETERANS
6. Assessment and Management of Dizziness and Visual Disturbances Following Concussion/Mild Traumatic Brain Injury: Guidance for the Primary Care Manager (Dept of Defense)
7. Evaluation of the Disability Determination Process for Traumatic Brain Injury in Veterans (211 pages)
Additional Resources:
The Ohio State University TBI Identification Method (OSU TBI-ID), Brain Injury Screening Questionnaire (BISQ), and Neurobehavioral Symptom Inventory (NSI) all align with the symptoms and focus areas covered in TBI Questionnaire.
- OSU TBI-ID focuses on lifetime history of TBI, identifying patterns of injury that may contribute to cognitive, emotional, and behavioral challenges.
- BISQ is designed to screen for symptoms related to attention, memory, mood, impulsivity, and physical effects of TBI.
- NSI tracks post-concussive symptoms like dizziness, headaches, fatigue, memory issues, and emotional regulation difficulties.
- CDC research highlights the importance of structured self-report screening tools in diverse settings to identify individuals with undiagnosed or untreated TBI.
Ohio State University TBI Identification Method: OSU TBD ID I Ohio State Brain Injury Prevention & Rehabilitation
Brain Injury Research Center Screening Tools | Icahn School of Medicine
Health.mil – Neurobehavioral Symptom Inventory form
