It is our pleasure to welcome you to Brainstorm. Please complete the following questionnaire. Your answers will help us to determine whether we can help you and your family. Please allow 10-15 minutes to complete this comprehensive health questionnaire.

The next step ( after completing the Intake Contact Form) is a review of your responses to determine a valid pathway or approach. Our comprehensive examination detailing your general and neurological health may be arranged.

Head impacts can be associated with serious and potentially fatal brain injuries. The BIMHI is to be used for the identification of suspected concussion. It is not designed to diagnose concussion.

 STEP 1: RED FLAGS — CALL AN AMBULANCE
If there is concern after an injury including whether ANY of the following signs are observed or complaints are reported then the patient should be safely and immediately removed from play/game/activity. If no licensed healthcare professional is available, call an ambulance for urgent medical assessment:

Neck pain or tenderness
Severe or increasing headache
Deteriorating conscious state
Vomiting
Increasingly restless, agitated or combative
Do not attempt to move the player (other than required for airway support) unless trained to so do.
Do not remove a helmet or any other equipment unless trained to do so safely.
Double vision
Seizure or convulsion
Loss of consciousness
Weakness or tingling/ burning in arms or legs

Please note this information is strictly confidential.