Rivermead Post Concussion Symptoms Patient Questionnaire

After a head injury or accident some people experience symptoms which can cause worry or nuisance. We would like to know if you now suffer from any of the symptoms given below. As many of these symptoms occur normally, we would like you to compare yourself now with before the accident (i.e. over the last 24 hours).

For each one, please select the radio button closest to your answer

Not experienced at all No more of a problem A mild problem A moderate problem A severe problem
Feelings of Dizziness
Nausea and/or Vomiting
Noise Sensitivity, easily upset by loud noise
Sleep Disturbance
Fatigue, tiring more easily
Being Irritable, easily angered
Feeling Depressed or Tearful
Feeling Frustrated or Impatient
Forgetfulness, poor memory
Poor Concentration
Taking Longer to Think
Blurred Vision
Light Sensitivity, Easily upset by bright light
Double Vision