Baseline Testing Demographic Form
Fill out the following form before completing the impact test:


Code: 5EQM7YECIY
Your School? 
First Name: 
Last Name
Date of Birth (Month/Day/Year) 
MM
/
DD
/
YYYY
Current Grade in School
Gender
Clear selection
Race
Sports you play (or will play)
Have you ever had a concussion baseline test on the computer? 
Clear selection
Have you ever been diagnosed with a concussion
Clear selection
Submit
Clear form
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