Pocket SCAT2 Online

Home > New Patient Center > Online Forms > Pocket SCAT2 Online

Pocket SCAT2 Online

Player First Name *

Player Last Name *

Coach First Name

Coach Last Name

Team Name

Date of Injury

1. Symptoms

Check all of the symptoms that may have been present

Loss of ConsciousnessSeizure or ConvulsionAmnesiaHeadachePressure in HeadNeck PainNausea or VomitingDizzinessBlurred VisionBalance ProblemsSensitivity to LightSensitivity to NoiseFeeling slowed down Feeling like in a fogdont feel rightDifficulty ConcentratingDifficulty RememberingFatigue or Low EnergyDrowsinessConfusionMore EmotionalIrritabilitySadnessNervous or Anxious

2. Memory Function

Failure to answer all questions correctly may suggest a concussion. For each statement listed, please indicate whether it was answered correctly or incorrectly.

At which arena are we at now?

CorrectIncorrect

Which period is it now?

CorrectIncorrect

Who scored last in the game?

CorrectIncorrect

Which team did you play last week game?

CorrectIncorrect

Did your team win the last game?

CorrectIncorrect

3. Balance Testing

Pass or Fail more than 5 erros in 20 seconds may suggest a concussion

PassFail

Errors include: Lifting hands off of hips, opening the eyes, lifting forefoot or heel, stumbling, stepping or falling, or not remaining in starting position ofr 5 seconds

Enter the verification code in the box below.

Verification Code: *

Top

Newsletter Sign Up

3D Spine Simulator

Launch 3D Spine Simulator

Contact

ChiroCare
20 Duke St. Ste 106
Bedford, Nova Scotia B4A2Z5
Get Directions

Phone: 902-407-3400
Fax: 902-407-4020
Email Us

Pocket SCAT2 Online