This survey is for individuals living with a brain injury in Kansas. We would appreciate hearing about your experiences and opinions. Your feedback will help find ways that organizations in Kansas can better serve those with a brain injury.

A few notes about the survey:
  • Your responses will be anonymous.
  • It will take 30 to 45 minutes to complete.
  • If you are able, we ask that you complete the survey in its entirety. There are required question as you go through the online survey. As a thank you for your time, at the end of the survey, you can enter your name into a drawing for a chance to win an Amazon gift card.
  • You can return to this survey at any point as long as you use the same link from the same computer. 
Phone option. If you prefer to complete this survey on paper or over the phone instead, please contact Liz Gebhart-Morgan with Partners for Insightful Evaluation at liz@pievaluation.com or 402-417-0034.

Thank you in advance for your participation in this survey! Your input is incredibly valuable!
NOTE: This survey is meant to capture the experiences of the individual living with a brain injury. If you are assisting or filling out this survey on behalf of someone with a brain injury, please answer the questions from the point of view of the person with the brain injury.

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* 1. Age of your first brain injury:

Question Title

* 2. How many total brain injuries have you experienced?

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* 3. Indicate how many times you have experienced each type of brain injury listed below.

  Haven't experienced 1 time 2 - 4 times 5 or more times
Automobile or motorcycle accident
Assault/abuse/domestic violence
Bicycle accident/pedestrian incident
Brain tumor (benign or malignant)
Fall
Firearms/weapons (gunshot to the head)
Infection
Loss of oxygen supply (anoxia)
Near drowning incident
Sports related injury
Stroke/aneurysm
 
4% of survey complete.

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