CRC Resilient Mindset 5-week series application
Cultivating a positive and resilient mindset post-concussion. This series is sponsored by the Concussion Resource Center and FREE to individuals who have sustained concussion.

WEDNESDAYS 5:15 - 6:15 pm
APR 3 - MAY 1, 2024

To register, complete the application below. The course facilitator, Turi Hetherington, will contact you to confirm. Watch for an email coming from turihetherington@gmail.com 
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Name: *
e-mail address *
Cell phone (for text reminders) *
How did you hear about this series? *
Can you attend all 5 session?
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Have you had a concussion or are you a caregiver for someone who has? *
If you have had a concussion, how many and when?
What persistent symptoms are you experiencing such as headache, dizziness, neck pain, visual changes? Please list all.
How often do these symptoms occur? Are there specific triggers we should be aware of?
The course takes place upstairs. Can you walk up and down stairs safely and without assistance? *
What are a few of the reasons you decided to sign up for this course? *
Do you have any  questions, comments or concerns you'd like to share? *
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